Urethroplasty Outcomes Just as Good in Outpatient Setting

Emma Hitt, PhD

May 19, 2012

May 19, 2012 (Atlanta, Georgia) — In patients with urethral strictures, clinical outcomes were similar whether urethroplasty was conducted on an inpatient or outpatient basis, according to the findings of a retrospective chart review.

Dmitriy Nikolavsky, MD, from the University of Colorado Hospital in Aurora, and colleagues presented the findings in a moderated poster session here at the American Urological Association 2012 Annual Scientific Meeting.

Urethral strictures are related to scar tissue that results from trauma, ischemia, or inflammatory mechanisms. They can be treated with urethral dilation, urethral stents, or urethroplasty.

Dr. Nikolavsky's team describes a single institution's experience with outpatient urethroplasty, comparing outcomes with those of traditional inpatient urethroplasty.

A retrospective chart review was conducted from March 2003 to November 2011 to determine the clinical characteristics of patients with urethral strictures, such as age, stricture cause, stricture duration, previous treatments, type of urethroplasty procedure, urethroplasty complications, recurrence, and length of follow-up.

Strictures in patients who underwent anterior urethroplasty were associated with idiopathic causes in 41% of the 204 patients, with trauma in 21.6%, with hypospadias in 14.2%, were iatrogenic in 11.3%, were associated with infections or inflammation in 7.4%, and with unknown causes in 2.0%.

The most common location of the strictures were in the bulbous urethra (65.2%), within the penile urethra (17.2%), and within the panurethra (15.7%). Mean length was 4.2 cm (SD ± 3.6).

Resection of the stricture by excision with primary anastomosis was performed in 25.5% of patients; 27% were treated with the augmented anastomotic technique with buccal mucosal grafting. In addition, 34.3% of patients were treated without stricture excision with ventral or dorsal buccal mucosal grafting, 2.9% with fasciocutaneous flaps, and 10.3% with 2-stage repairs.

After urethroplasty, 15 (7.3%) patients were admitted for inpatient care — 14 were discharged by 23 hours and 1 was admitted for 5 days. During a mean follow-up of 11.1 months, 17.6% of patients experienced stricture recurrence at a mean of 7.5 months after surgery.

Adverse effects of urethroplasty, which occurred in 18.1% of patients, included urinary tract infection, urosepsis, catheter obstruction, transient pericatheter contrast extravasation, wound infection, and wound separation. In addition, 13.1% of patients experienced long-term complications, such as postvoiding leakage, urinary tract infections, erectile dysfunction, penile chordee, and urethrocutaneous fistula.

"Outpatient urethroplasty is feasible in most patients; our outcomes are similar to the traditional inpatient approach," the authors conclude in their abstract.

The study was not commercially funded. Dr. Nikolavsky has disclosed no relevant financial relationships.

American Urological Association (AUA) 2012 Annual Scientific Meeting: Abstract 16. Presented May 19, 2012.