Urologia médica e cirúrgica
Acesso livre

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Direct Visual Internal Urethrotomy after Failed Bulbar Urethroplasty

Jonathan N Warner, Min S Jun, Ibraheem M Malkawi and Richard A Santucci

Introduction: Ideal management of failed bulbar urethroplasty is ill defined. The role of direct visual internal urethrotomy (DVIU) as salvage treatment for failed urethroplasty warrants exploration.

Material and methods: Patients who failed urethroplasty (buccal or anastomotic) for bulbar urethral stricture from April 2000-April 2013 were reviewed. Demographics, prior treatments, stricture length, and operative approach were evaluated for risk of salvage DVIU failure.

Results: Forty-five patients underwent 11 anastomotic and 34 buccal mucosal urethroplasties. Mean stricture length was 3.9cm (0.5- 9cm), mean follow-up was 40 months (12-160 months) and mean time to failure was 20 months (1-133 months). Upon failure, 4 patients underwent redo urethroplasty, and 41 underwent DVIU. Patients treated with immediate redo urethroplasty had no recurrence. 56% (23/41) treated with initial DVIU had no recurrence. Analysis of age, original and recurrent stricture length, and number of preoperative dilations or DVIUs showed no difference between those with and without recurrent stricture after DVIU. No significant difference in failure of salvage DVIU between anastomotic and buccal mucosal grafting was seen. Cox regression analysis showed no significant difference in time to recurrence after salvage DVIU based on anastomotic versus buccal (p=0.3), initial or recurrent stricture length, total prior dilations or DVIUs, and age. Secondary salvage procedures included 11 urethroplasties (successful in 8/11(72%)), and 5 redo DVIU (successful in 2/5 (40%)).

Conclusions: Salvage DVIU is an appropriate initial treatment of recurrent bulbar urethral stricture after urethroplasty. When this fails, redo urethroplasty has a high success rate.