Research Article
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Risk Factors Affecting Success of Urethroplasty in Male Patients – Single Center Results

Year 2021, Volume: 18 Issue: 3, 410 - 416, 29.12.2021
https://doi.org/10.35440/hutfd.1007386

Abstract

Background: In this study, male patients who underwent urethroplasty in our clinic were examined, and the outcome of the cases and the risk factors affecting the success of urethroplasty were investigated.
Materials and Methods: In this retrospective study, univariate and multivariate analyzes were used to determine the factors affecting treatment success following different urethroplasty techniques performed by a single surgeon in male patients with urethral stricture.
Results: In the urethroplasty cases performed in 102 male patients, the mean age was 49 years, the mean stenosis length was 3.9 cm, and the success rate was 84%. According to the results of the multivariate analysis, the presence of diabetes mellitus (DM), the number of previous urethratomy interna (IU) and the length of the stenosis were defined as the factors predicting the success of urethroplasty. (OR 1.257; 95% CI 0.073-0.909; p=0.035, OR 5.343; 95% CI 2.233-12.782; p=0.005 and OR 8.683; 95% CI 2.950-25.561; p=0.025)
Conclusions: Although urethroplasty is the gold standard surgical procedure in the treatment of urethral strictures, the presence of DM, multiple IU history, and long strictures are associated with treatment failure. Urethroplasty techniques should be evaluated with multiple factors and performed in experienced centers.

Keywords: Urethral Stricture; urethroplasty; Graft Urethroplasty; end-to-end anastomosis

References

  • A. R. Mundy , D. E. Andrich. Urethral trauma. Part I: Introduction, history, anatomy, pathology, assessment and emergency management. BJU International, 2011; 108(3):310-327.
  • M. R. Cooperberg, J. W. McAninch, N. F. Alsikafi, S. P. Elliott. Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience . J. Urol. 2007; 178(5):2006-2010.
  • G. G. Ferguson, T. L. Bullock, R. E. Anderson, R. E. Blalock, S. B. Brandes. Minimally invasive methods for bulbar urethral strictures: A survey of members of the American urological association. Urology, 2011; 78(3):701-706.
  • H. Wessells, K.W Angermeier, S. Elliott, C.M. Gonzalez, R.Kodama, A.C. Peterson et al. Male Urethral Stricture: American Urological Association Guideline. J. Urol. 2017; 197(1):182-190.
  • J. M. Latini, J. W. McAninch, S. B. Brandes, J. Y. Chung, D. Rosenstein. SIU/ICUD consultation on urethral strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology. 2014; 83(Suppl 3):1-7.
  • G. Barbagli, F.Montorsi, S.Balo, S.Sansalone, C.Loreto, D.Butnaru et al. Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results. World J. Urol. 2019; 37(6):1165-1171.
  • D. Chapman, A. Kinnaird, K. Rourke. Independent Predictors of Stricture Recurrence Following Urethroplasty for Isolated Bulbar Urethral Strictures . J. Urol. 2017; 198(5):1107-1112.
  • C. Fuehner, R. Dahlem, M. Fisch, M. W. Vetterlein. Update on managing anterior urethral strictures. Indian Journal of Urology. 2019; 35(2): 94-100.
  • F. C.-J. N. Lumen (Chair), N. O. K. Dimitropoulos, T. Greenwell, F.E. Martins, M. W. S. Riechardt, F. E. Guidelines Associates: R. Barratt, G. Chan, and W. V. R. La Rocca, A. Ploumidis, “EAU Guidelines on Urethral Strictures | Uroweb,” European Association of Urology, 2021. https://uroweb.org/guideline/urethral-strictures/#6 (accessed Aug. 01, 2021).
  • E.Robine, J.Rigaud, F.Luyckx, Q.-C Le Clerc, F.-X Madec, O.Bouchot et al. Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review. Prog. Urol. 2017; 27(2): 49-57.
  • R. Santucci , L. Eisenberg. Urethrotomy Has a Much Lower Success Rate Than Previously Reported. J. Urol. 2010; 183(5): 1859-1862.
  • J. Choi, C. U. Lee, H. H. Sung. Learning curve of various type of male urethroplasty. Investig. Clin. Urol. 2020; 61(5): 508-513.
  • S. W. Waxman , A. F. Morey. Management of urethral strictures. 2006; 367(9520): 1379-1380.
  • G. Barbagli, E. Palminteri, M. Lazzeri, G. Guazzoni, D. Turini. Long-Term Outcome Of Urethroplasty After Failed Urethrotomy Versus Primary Repair. J. Urol. 2001; 165(6 Pt 1): 1918-1919.
  • S. J. Hudak, T. H. Atkinson, A. F. Morey. Repeat transurethral manipulation of bulbar urethral strictures is associated with increased stricture complexity and prolonged disease duration. J. Urol. 2012; 187(5): 1691-1695.
  • T. M. Kessler, F. Schreiter, G. Kralidis, M. Heitz, R. Olianas, M. Fisch. Long-term results of surgery for urethral stricture: A statistical analysis. J. Urol. 2003; 170(3): 840-844.
  • S. D. Blaschko, J. W. McAninch, J. B. Myers, B. J. Schlomer, B. N. Breyer. Repeat urethroplasty after failed urethral reconstruction: Outcome analysis of 130 patients. J. Urol. 2012; 188(6): 2260-2264.
  • B. N. Breyer, J.W.McAninch, J.M.Whitson, M.L.Eisenberg, J.F.Mehdizadeh, J.B Myers et al. Multivariate Analysis of Risk Factors for Long-Term Urethroplasty Outcome. J. Urol. 2010; 183(2): 613-617.
  • A.F. Morey , W.S. Kizer . Proximal bulbar urethroplasty via extended anastomotic approach--what are the limits?. J. Urol. 2006; 175(6): 2145-9.
  • A. K. Choudhary , N. K. Jha. Is anastomotic urethroplasty is really superior than BMG augmented dorsal onlay urethroplasty in terms of outcomes and patient satisfaction: Our 4-year experience. Can. Urol. Assoc. J. 2015; 9(1-2): E22-26.
  • P. Joshi , C.Kaya, S.Surana, D.J. Desai, H.Orabi, S.Iyer et al. Ön üretra darlığının tanısına karar vermede yeni bir yöntem: Metilen mavisi boyasının kullanılması. Turkish J. Urol. 2017; 43(4): 502-506.
  • F.Yalçınkaya , İ.Kartal .Critical analysis of urethroplasty for male anterior urethral stricture: a single-center experience, World J. Urol. 2020; 38(9): 2313-2319.
  • M. L. Guralnick , G. D. Webster. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J. Urol. 2001; 165(5): 1496-1501.
  • B. M. Browne , A. J. Vanni. Use of Alternative Techniques and Grafts in Urethroplasty. Urologic Clinics of North America. 2017; 44(1): 127-140.
  • S. Bhargava , C. R. Chapple. Buccal mucosal urethroplasty: Is it the new gold standard?. BJU International. 2004; 93(9): 1191-1193.
  • G. Bakbagli, E. Palminteri, G. Guazzoni, F. Montorsi, D. Turini, M. Lazzeri. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?. J. Urol. 2005; 174(3): 955-958.
  • A. Şimşek, M.G.Yenice, K.G. Şeker, Y.Arıkan, Y.Çolakoğlu, E.Şam et al. Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty. Turkish J. Urol. 2019; 45(3): 223.
  • A. Simsek, R. Aldamanhori, C. R. Chapple, S. MacNeil. Overcoming scarring in the urethra: Challenges for tissue engineering. Asian Journal of Urology. 2018; 5(2): 69-77.

Erkek Hastalarda Üretroplasti Başarısını Etkileyen Risk Faktörleri – Tek Merkez Sonuçları

Year 2021, Volume: 18 Issue: 3, 410 - 416, 29.12.2021
https://doi.org/10.35440/hutfd.1007386

Abstract

Giriş: Bu çalışmada kliniğimizde üretroplasti yapılan erkek hastalar incelenerek olguların sonuçları ve üretroplasti başarısı üzerine etkili risk faktörleri araştırıldı.
Materyal ve Metod: Bu retrospektif çalışmada, üretra darlığı olan erkek hastalarda tek cerrah tarafından uygulanan farklı üretroplasti tekniklerini takiben tedavi başarısını etkileyen faktörleri belirlemek için tek değişkenli ve çok değişkenli analizler kullanılmıştır.
Bulgular: 102 erkek hastada gerçekleştirilen üretroplasti vakalarında ortalama yaş 49 yıl, ortalama darlık uzunluğu 3,9 cm ve başarı oranı % 84 olarak belirlendi. Çok değişkenli analiz sonuçlarına göre diyabetes mellitus (DM) varlığı, önceden geçirilmiş üretratomi interna (İÜ) sayısı ve darlık uzunluğu üretroplasti başarısını öngören faktörler olarak tanımlandı. (HR 0.257; 95% CI 0.073-0.909 ; p=0.035 , HR 5.343; 95% CI 2.233-12.782; p=0.005 ve HR 8.683;% 95 CI 2.950-25.561; p=0.025)
Sonuç: Üretroplasti, üretra darlığı tedavisinde altın standart bir cerrahi prosedür olmakla beraber DM varlığı, birden çok İÜ öyküsü ve uzun darlıklar tedavi başarısızlığı ile ilişkilidir. Üretroplasti teknikleri birden çok faktör ile değerlendirilmeli ve deneyimli merkezlerde gerçekleştirilmelidir.

References

  • A. R. Mundy , D. E. Andrich. Urethral trauma. Part I: Introduction, history, anatomy, pathology, assessment and emergency management. BJU International, 2011; 108(3):310-327.
  • M. R. Cooperberg, J. W. McAninch, N. F. Alsikafi, S. P. Elliott. Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience . J. Urol. 2007; 178(5):2006-2010.
  • G. G. Ferguson, T. L. Bullock, R. E. Anderson, R. E. Blalock, S. B. Brandes. Minimally invasive methods for bulbar urethral strictures: A survey of members of the American urological association. Urology, 2011; 78(3):701-706.
  • H. Wessells, K.W Angermeier, S. Elliott, C.M. Gonzalez, R.Kodama, A.C. Peterson et al. Male Urethral Stricture: American Urological Association Guideline. J. Urol. 2017; 197(1):182-190.
  • J. M. Latini, J. W. McAninch, S. B. Brandes, J. Y. Chung, D. Rosenstein. SIU/ICUD consultation on urethral strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology. 2014; 83(Suppl 3):1-7.
  • G. Barbagli, F.Montorsi, S.Balo, S.Sansalone, C.Loreto, D.Butnaru et al. Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results. World J. Urol. 2019; 37(6):1165-1171.
  • D. Chapman, A. Kinnaird, K. Rourke. Independent Predictors of Stricture Recurrence Following Urethroplasty for Isolated Bulbar Urethral Strictures . J. Urol. 2017; 198(5):1107-1112.
  • C. Fuehner, R. Dahlem, M. Fisch, M. W. Vetterlein. Update on managing anterior urethral strictures. Indian Journal of Urology. 2019; 35(2): 94-100.
  • F. C.-J. N. Lumen (Chair), N. O. K. Dimitropoulos, T. Greenwell, F.E. Martins, M. W. S. Riechardt, F. E. Guidelines Associates: R. Barratt, G. Chan, and W. V. R. La Rocca, A. Ploumidis, “EAU Guidelines on Urethral Strictures | Uroweb,” European Association of Urology, 2021. https://uroweb.org/guideline/urethral-strictures/#6 (accessed Aug. 01, 2021).
  • E.Robine, J.Rigaud, F.Luyckx, Q.-C Le Clerc, F.-X Madec, O.Bouchot et al. Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review. Prog. Urol. 2017; 27(2): 49-57.
  • R. Santucci , L. Eisenberg. Urethrotomy Has a Much Lower Success Rate Than Previously Reported. J. Urol. 2010; 183(5): 1859-1862.
  • J. Choi, C. U. Lee, H. H. Sung. Learning curve of various type of male urethroplasty. Investig. Clin. Urol. 2020; 61(5): 508-513.
  • S. W. Waxman , A. F. Morey. Management of urethral strictures. 2006; 367(9520): 1379-1380.
  • G. Barbagli, E. Palminteri, M. Lazzeri, G. Guazzoni, D. Turini. Long-Term Outcome Of Urethroplasty After Failed Urethrotomy Versus Primary Repair. J. Urol. 2001; 165(6 Pt 1): 1918-1919.
  • S. J. Hudak, T. H. Atkinson, A. F. Morey. Repeat transurethral manipulation of bulbar urethral strictures is associated with increased stricture complexity and prolonged disease duration. J. Urol. 2012; 187(5): 1691-1695.
  • T. M. Kessler, F. Schreiter, G. Kralidis, M. Heitz, R. Olianas, M. Fisch. Long-term results of surgery for urethral stricture: A statistical analysis. J. Urol. 2003; 170(3): 840-844.
  • S. D. Blaschko, J. W. McAninch, J. B. Myers, B. J. Schlomer, B. N. Breyer. Repeat urethroplasty after failed urethral reconstruction: Outcome analysis of 130 patients. J. Urol. 2012; 188(6): 2260-2264.
  • B. N. Breyer, J.W.McAninch, J.M.Whitson, M.L.Eisenberg, J.F.Mehdizadeh, J.B Myers et al. Multivariate Analysis of Risk Factors for Long-Term Urethroplasty Outcome. J. Urol. 2010; 183(2): 613-617.
  • A.F. Morey , W.S. Kizer . Proximal bulbar urethroplasty via extended anastomotic approach--what are the limits?. J. Urol. 2006; 175(6): 2145-9.
  • A. K. Choudhary , N. K. Jha. Is anastomotic urethroplasty is really superior than BMG augmented dorsal onlay urethroplasty in terms of outcomes and patient satisfaction: Our 4-year experience. Can. Urol. Assoc. J. 2015; 9(1-2): E22-26.
  • P. Joshi , C.Kaya, S.Surana, D.J. Desai, H.Orabi, S.Iyer et al. Ön üretra darlığının tanısına karar vermede yeni bir yöntem: Metilen mavisi boyasının kullanılması. Turkish J. Urol. 2017; 43(4): 502-506.
  • F.Yalçınkaya , İ.Kartal .Critical analysis of urethroplasty for male anterior urethral stricture: a single-center experience, World J. Urol. 2020; 38(9): 2313-2319.
  • M. L. Guralnick , G. D. Webster. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J. Urol. 2001; 165(5): 1496-1501.
  • B. M. Browne , A. J. Vanni. Use of Alternative Techniques and Grafts in Urethroplasty. Urologic Clinics of North America. 2017; 44(1): 127-140.
  • S. Bhargava , C. R. Chapple. Buccal mucosal urethroplasty: Is it the new gold standard?. BJU International. 2004; 93(9): 1191-1193.
  • G. Bakbagli, E. Palminteri, G. Guazzoni, F. Montorsi, D. Turini, M. Lazzeri. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?. J. Urol. 2005; 174(3): 955-958.
  • A. Şimşek, M.G.Yenice, K.G. Şeker, Y.Arıkan, Y.Çolakoğlu, E.Şam et al. Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty. Turkish J. Urol. 2019; 45(3): 223.
  • A. Simsek, R. Aldamanhori, C. R. Chapple, S. MacNeil. Overcoming scarring in the urethra: Challenges for tissue engineering. Asian Journal of Urology. 2018; 5(2): 69-77.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Yavuz Onur Danacioglu 0000-0002-3170-062X

Ubeyd Sungur 0000-0002-8910-9859

Fatih Akkaş 0000-0002-4560-7426

Mert Birinci 0000-0002-1254-2486

Mustafa Soytaş 0000-0002-3474-3510

Abdülmüttalip Şimşek 0000-0001-8003-4654

Publication Date December 29, 2021
Submission Date October 8, 2021
Acceptance Date November 4, 2021
Published in Issue Year 2021 Volume: 18 Issue: 3

Cite

Vancouver Danacioglu YO, Sungur U, Akkaş F, Birinci M, Soytaş M, Şimşek A. Erkek Hastalarda Üretroplasti Başarısını Etkileyen Risk Faktörleri – Tek Merkez Sonuçları. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021;18(3):410-6.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty