Improving Outcomes of Bulbomembranous Urethroplasty for Radiation-induced Urethral Strictures in Post-Urolume Era

• Published in: Urology (Ridgewood, N.J.) N.J.), 2017-01, Vol.99, p.240-245
• Main Authors: Fuchs, Joceline S, Hofer, Matthias D, Sheth, Kunj R, Cordon, Billy H, Scott, Jeremy M, Morey, Allen F
• Format: Article
• Language: English
• Subjects: Aged; Anastomosis, Surgical - methods; Colorectal Neoplasms - radiotherapy; Cystoscopy; Follow-Up Studies; Humans; Male; Prostatic Neoplasms - radiotherapy; Radiation Injuries - complications; Radiation Injuries - diagnosis; Radiation Injuries - surgery; Reconstructive Surgical Procedures - methods; Retrospective Studies; Severity of Illness Index; Stents; Time Factors; Treatment Outcome; Urethra - radiation effects; Urethra - surgery; Urethral Stricture - diagnosis; Urethral Stricture - etiology; Urethral Stricture - surgery; Urologic Surgical Procedures, Male - methods; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2016.07.031

Objective To evaluate contemporary outcomes of excision and primary anastomosis (EPA) for the treatment of radiation-induced urethral strictures (RUS). Patients and Methods A retrospective review of 72 patients undergoing EPA for RUS from 2007 to 2015 by a single surgeon was performed. We analyzed overall and long-term success rates of EPA urethroplasty and compared patient cohorts from two groups, 2007-2012 vs 2013-2015 (post-Urolume). Results During the course of the study, we noted a near doubling of patient volume from the earlier (6.2 patients/year) to later (11.7 patients/year) cohorts. Among the 37 men treated from 2007 to 2012, we identified an EPA success rate of 70% compared with the improved 86% success rate in the subsequent cohort of 35 men treated from 2013 to 2015 ( P  = .07). Single dilation was successful in 50% of initial and 40% of subsequent cohort patients in the treatment of recurrence. Initial and subsequent cohorts varied only in regard to stricture length (mean 2.0 cm vs 3.0 cm in initial and subsequent cohorts, P  = .001) and number treated with Urolume stent (initial 5 vs none in the later cohort, P  = .03). Length of follow-up (median 50 [17-97] months for the initial and 22 [6-34] months for the later cohort) was not associated with recurrence. Conclusion Increasing numbers of RUS patients are presenting for urethral reconstruction in the post-Urolume era. With increasing experience, we improved success rates of EPA urethroplasty to over 85% despite increased stricture length.