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Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique from a Multi-Institutional Surgical Outcomes Research Group.

  • Author(s): Cotter, Katherine J
  • Hahn, Amy E
  • Voelzke, Bryan B
  • Myers, Jeremy B
  • Smith, Thomas G
  • Elliott, Sean P
  • Alsikafi, Nejd F
  • Breyer, Benjamin N
  • Vanni, Alex J
  • Buckley, Jill C
  • Zhao, Lee C
  • Broghammer, Joshua A
  • Erickson, Bradley A
  • Trauma and Urologic Reconstruction Network of Surgeons (TURNS)
  • et al.
Abstract

OBJECTIVES:To analyze contemporary urethroplasty trends and urethral stricture etiologies over a seven-year study period amongst urologists from a large multi-institutional surgical outcomes group. METHODS:Review of a multi-institutional, prospectively maintained urethroplasty database was performed on 2,098 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. RESULTS: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%) versus 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%). CONCLUSIONS:Anterior urethroplasty techniques continue to evolve in the absence of robust clinical data or randomized controlled trials, with a general movement in this cohort towards an initial dorsal approach for most strictures. Inter and intra-surgeon 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.

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