Journal article
Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence?
Urology (Ridgewood, N.J.), Vol.145, pp.262-268
11/2020
DOI: 10.1016/j.urology.2020.05.109
PMID: 32763321
Abstract
To demonstrate our hypothesis that the presence of extravasation on postoperative urethrogram is inconsequential for disease recurrence in urethroplasty postoperative follow-up.
We utilized the Trauma and Urologic Reconstructive Network of Surgeons database to assess 1691 patients who underwent urethroplasty and post-operative urethrogram. Anatomic and functional recurrence were defined as <17 Fr stricture documented at 12-month cystoscopy and need for a secondary procedure during 1 year of follow-up, respectively. Our primary outcomes were the sensitivity and positive predictive value of post-operative urethrogram for predicting anatomic and functional recurrence of urethral stricture disease.
Among 1101 patients with cystoscopy follow-up, 54 (4.9%) had extravasation on initial postoperative urethrogram. Among those 54, 74.1% developed an anatomic recurrence vs 13% without extravasation (P <.001). Similarly, functional recurrence was 9.3% with extravasation vs 3.2 % without extravasation (P = .04). Patients with extravasation more often reported a postoperative urinary tract infection (12.9% vs 2.7%; P <.01) or wound infection (7.4% vs 2.6%; P = .04). Sensitivity of postoperative urethrogram in predicting any recurrence was 27.3%, specificity 98.7%, positive predictive value 77.8%, and negative predictive value 89.3%. Fourty-five of 54 patients with extravasation had a recurrence of some kind, equating to a 22.2% urethroplasty success rate at 1 year.
Postoperative urethrogram has a high specificity but low sensitivity for anatomic and functional recurrence during short term follow-up. The positive predictive value of urinary extravasation is high: patients with extravasation incur a high risk of anatomic recurrence within 1 year and such patients may warrant increased monitoring.
Details
- Title: Subtitle
- Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence?
- Creators
- German Patino - University of California, San FranciscoAndrew J Cohen - Johns Hopkins UniversityAlex J Vanni - Lahey Hospital and Medical CenterBryan B Voelzke - University of Washington Medical CenterThomas G Smith III - Baylor College of MedicineBradley A Erickson - University of IowaSean P Elliott - University of MinnesotaNedj F Alsikafi - Uropartners, Gurnee, ILJill C Buckley - University of California San DiegoLee Zhao - NYU Langone HealthJeremy B Myers - University of UtahAnthony Enriquez - University of California, San FranciscoBenjamin N Breyer - University of California, San FranciscoTrauma and Urologic Reconstruction Network of Surgeons (TURNS)
- Resource Type
- Journal article
- Publication Details
- Urology (Ridgewood, N.J.), Vol.145, pp.262-268
- DOI
- 10.1016/j.urology.2020.05.109
- PMID
- 32763321
- NLM abbreviation
- Urology
- ISSN
- 0090-4295
- eISSN
- 1527-9995
- Language
- English
- Date published
- 11/2020
- Academic Unit
- Urology
- Record Identifier
- 9984319970702771
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