To describe the outcomes of single-stage and staged repairs in properly selected patients with phalloplasty anastomotic strictures.
A bi-institutional retrospective review was performed of all patients who underwent anastomotic stricture repairs between 7/2014-8/2020. Those who had prior augmented urethroplasties or poorly vascularized tissue underwent two-stage repairs (Group-2), all others underwent single-stage repair with a double-face (dorsal inlay and ventral onlay) buccal mucosal graft urethroplasty (Group-1). Postoperatively, urethral patency and patient reported outcome measures (PROMs) were assessed.
Twenty-three patients with anastomotic strictures were identified. Fourteen patients met inclusion criteria and had 1-year follow-up (9 in Group-1; 5 in Group-2). Nine patients (64%) had prior failed interventions (56% Group-1; 80% Group-2). At a mean follow-up of 33.9 (Group-1) and 35.2 months (Group-2) there were two stricture recurrences in Group-1 (22%) and none in Group-2. PROMs were completed by 12 patients. All patients reported the ability to void standing. Post-void dribbling was present in the majority of patients (7/7 Group-1; 2/4 in Group-2). Mean IPSS was 3.9 (0-14) for Group-1 and 1 (0-3) for Group-2. All reported at least a moderate improvement in their condition on GRA (Group-1 +3 71%, +2 29%; Group-2 +3 100%).
Single-stage repairs are feasible for patients with anastomotic strictures who have well vascularized tissue and no prior single-stage buccal mucosa augmented urethroplasty failures. Staged repairs are feasible for patients with poor tissue quality. Proper patient selection is important for successful reconstruction.
Urology. 2021 Jun 10 [Epub ahead of print]
Matthew R Beamer, Jessica Schardein, Nabeel Shakir, Min Suk Jun, Rachel Bluebond-Langner, Lee C Zhao, Dmitriy Nikolavsky
Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA., Department of Urology, New York University Langone Health, New York, NY, USA., Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA., Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA. Electronic address: .