Assessment of the Male Urethral Reconstruction Learning Curve

Sarah F Faris; Jeremy B Myers; Bryan B Voelzke; Sean P Elliott; Benjamin N Breyer; Alex J Vanni; Christopher A Tam; Bradley A Erickson

doi:10.1016/j.urology.2015.11.038

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Assessment of the Male Urethral Reconstruction Learning Curve

Journal article

Open access

Peer reviewed

Assessment of the Male Urethral Reconstruction Learning Curve

Sarah F Faris, Jeremy B Myers, Bryan B Voelzke, Sean P Elliott, Benjamin N Breyer, Alex J Vanni, Christopher A Tam and Bradley A Erickson

Urology (Ridgewood, N.J.), Vol.89, pp.137-143

03/2016

DOI: 10.1016/j.urology.2015.11.038

PMCID: PMC4792781

PMID: 26723182

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Abstract

To evaluate the urethroplasty learning curve. Published success rates of urethral reconstruction for urethral stricture disease are high even though these procedures can be technically demanding. It is likely that success rates improve with time although a learning curve for urethral reconstruction has never been established. We retrospectively reviewed anterior urethroplasties from a prospectively maintained multi-institutional database. Success was analyzed at the 18-month mark in all patients and defined as freedom from secondary operation for stricture recurrence. A multivariate logistic regression was performed for outcomes vs time from fellowship and case number. A total of 613 consecutive cases from 6 surgeons were analyzed, with a functional success rate of 87.3%. The success rate for bulbar urethroplasties was higher than that for penile urethroplasties (88.2% vs 78.3%, P = .0116). The success rate of anastomotic repairs was higher than that for substitution repairs (95.0% vs 82.4%, P = .0001). There was a statistically significant trend toward improved outcomes with increasing number of cases (P = .0422), which was most pronounced with bulbar repairs. There was no statistical improvement in penile repairs over time. The case number to reach proficiency (>90% success) was approximately 100 cases for all types of reconstruction and 70 cases for bulbar urethroplasty. There were statistical differences in success rates among the participating surgeons (P = .0014). Complications decreased with time (P = .0053). This study shows that success rates of anterior urethral reconstruction improve significantly with surgeon experience. Proficiency occurs after approximately 100 cases.

Urethra - surgery

Urethral Stricture - surgery

Urologic Surgical Procedures, Male - education

Urologic Surgical Procedures, Male - statistics & numerical data

Humans

Urologic Surgical Procedures, Male - methods

Male

Retrospective Studies

Learning Curve

Details

Title: Subtitle: Assessment of the Male Urethral Reconstruction Learning Curve
Creators: Sarah F Faris - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA
Jeremy B Myers - Division of Urology, University of Utah, Salt Lake City, UT
Bryan B Voelzke - Department of Urology, University of Washington, Seattle, WA
Sean P Elliott - Department of Urology, University of Minnesota, Minneapolis, MN
Benjamin N Breyer - Department of Urology, University of California, San Francisco, CA
Alex J Vanni - Department of Urology, Lahey Clinic, Burlington, MA
Christopher A Tam - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA
Bradley A Erickson - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: brad-erickson@uiowa.edu
Resource Type: Journal article
Publication Details: Urology (Ridgewood, N.J.), Vol.89, pp.137-143
DOI: 10.1016/j.urology.2015.11.038
PMID: 26723182
PMCID: PMC4792781
NLM abbreviation: Urology
ISSN: 0090-4295
eISSN: 1527-9995
Publisher: United States
Grant note: T35 HL007485 / NHLBI NIH HHS K12 DK083021 / NIDDK NIH HHS
Language: English
Date published: 03/2016
Academic Unit: Urology
Record Identifier: 9984051557902771

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