The outome of revisional urethroplasty surgery
BAUS ePoster online library. Ivaz S. 06/24/19; 259526; P4-11
Ms. Stella Ivaz
Ms. Stella Ivaz
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Abstract
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Introduction
This study evaluates the outcome of redo-urethroplasty with particular view to identifying factors constituting complexity and any difference in outcome of revisional surgery on the different anatomic segments of the urethra.

METHODS

Over ten years, 51 redo-bulbar, 133 redo-penile and 48 redo-posterior urethroplasties following pelvic trauma (PFUI) were performed. Minimum follow-up was five years. Patients were followed up clinically, radiologically and by flow-rate assessment.

RESULTS

Restricture rate for redo-bulbar urethroplasty was 4% (3.5% for primary). Recurrence rate increased significantly in patients having had 3 or more previous urethroplasties. 18.8% of revisional penile urethroplasty recurred (10% in primary). Recurrence was commonest in salvage hypospadias surgery(18%). Small glans, paucity of dartos and a thin spongiosum were poor prognostic factors in penile revision surgery. For bulbar and penile redo-urethroplasty, revision commonly involved a more complex procedure than the primary. Following PFUI redo-urethroplasty, recurrence rate was 12.5% (5.4% in primary). The redo-procedure was usually further down the 'step-wise progression' approach than the primary procedure. Associated pathologies like bladder neck injury or uro-rectal fistula increased complexity. Median time to stricture recurrence for all revisions was three months.

Conclusions
Bulbar urethroplasty has the best results both for primary and revisional surgery even when the revision is more complicated.
Penile urethroplasty has less satisfactory results; is technically more demanding and has many more complicating factors especially in redo-surgery.
Posterior urethroplasty also has a number of complicating factors and is technically more demanding especially in redo-surgery. This emphasises the importance of successful primary intervention in these cases.
Introduction
This study evaluates the outcome of redo-urethroplasty with particular view to identifying factors constituting complexity and any difference in outcome of revisional surgery on the different anatomic segments of the urethra.

METHODS

Over ten years, 51 redo-bulbar, 133 redo-penile and 48 redo-posterior urethroplasties following pelvic trauma (PFUI) were performed. Minimum follow-up was five years. Patients were followed up clinically, radiologically and by flow-rate assessment.

RESULTS

Restricture rate for redo-bulbar urethroplasty was 4% (3.5% for primary). Recurrence rate increased significantly in patients having had 3 or more previous urethroplasties. 18.8% of revisional penile urethroplasty recurred (10% in primary). Recurrence was commonest in salvage hypospadias surgery(18%). Small glans, paucity of dartos and a thin spongiosum were poor prognostic factors in penile revision surgery. For bulbar and penile redo-urethroplasty, revision commonly involved a more complex procedure than the primary. Following PFUI redo-urethroplasty, recurrence rate was 12.5% (5.4% in primary). The redo-procedure was usually further down the 'step-wise progression' approach than the primary procedure. Associated pathologies like bladder neck injury or uro-rectal fistula increased complexity. Median time to stricture recurrence for all revisions was three months.

Conclusions
Bulbar urethroplasty has the best results both for primary and revisional surgery even when the revision is more complicated.
Penile urethroplasty has less satisfactory results; is technically more demanding and has many more complicating factors especially in redo-surgery.
Posterior urethroplasty also has a number of complicating factors and is technically more demanding especially in redo-surgery. This emphasises the importance of successful primary intervention in these cases.
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