Journal article
Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group
Urology (Ridgewood, N.J.), Vol.130, pp.167-174
08/2019
DOI: 10.1016/j.urology.2019.01.046
PMID: 30880075
Abstract
To analyze contemporary urethroplasty trends and urethral stricture etiologies over a 7-year study period among urologists from a large multi-institutional surgical outcomes group.
Review of a multi-institutional, prospectively maintained urethroplasty database was performed on 2098 anterior urethroplasties done between 2010 and 2017 by 10 surgeons. Stricture characteristics, including etiology, length, and anatomic location were analyzed and compared to urethroplasty type over the study period using chi-squared analysis to assess for linear trends within the group and by surgeon.
Average stricture lengths for bulbar (2.8 ± 1.8 cm), penile (3.6 ± 2.6 cm), and penile-bulbar strictures (8.7 ± 5.0) remained stable. The most common stricture etiology was idiopathic/unknown in all study years (63%). In the bulbar urethra, the group performed significantly (1) fewer excisional repairs (-31%) and more substitutional repairs (+78%); (2) of substitutional repairs, more grafts are being placed dorsally (+95%) vs ventrally (-75%) (3) of the bulbar excisional repairs, more are being performed without transection of the bulbar urethra (+430%); and in the penile urethra (4) the fasciocutaneous flap is in decline (-86%), while single-stage dorsal repairs are increasing (+280%).
Anterior urethroplasty techniques continue to evolve in the absence of robust clinical data or randomized controlled trials, with a general movement in this cohort toward an initial dorsal approach for most strictures. Inter- and intrasurgeon variability in the surgical management of similar strictures was noted, and the feasibility of any future randomized controlled trials, without apparent surgical equipoise, must be questioned.
Details
- Title: Subtitle
- Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group
- Creators
- Katherine J Cotter - Department of Urology, University of Iowa, Iowa City, IAAmy E Hahn - Department of Urology, University of Iowa, Iowa City, IABryan B Voelzke - University of Washington, Seattle, WAJeremy B Myers - University of Utah, Salt Lake City, UTThomas G Smith III - Baylor College of Medicine, Houston, TXSean P Elliott - University of Minnesota, Minneapolis, MNNejd F Alsikafi - Uropartners, Gurnee, ILBenjamin N Breyer - University of California, San Francisco, San Francisco, CAAlex J Vanni - Lahey Hospital and Medical Center, Burlington, MAJill C Buckley - University of California, San Diego, San Diego, CALee C Zhao - New York University, New York, NYJoshua A Broghammer - University of Kansas Medical Center, Kansas City, KSBradley A Erickson - Department of Urology, University of Iowa, Iowa City, IA. Electronic address: brad-erickson@uiowa.eduTrauma and Urologic Reconstruction Network of Surgeons (TURNS)
- Resource Type
- Journal article
- Publication Details
- Urology (Ridgewood, N.J.), Vol.130, pp.167-174
- Publisher
- United States
- DOI
- 10.1016/j.urology.2019.01.046
- PMID
- 30880075
- ISSN
- 0090-4295
- eISSN
- 1527-9995
- Language
- English
- Date published
- 08/2019
- Academic Unit
- Urology
- Record Identifier
- 9984051569302771
Metrics
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