PURPOSE: To evaluate stricture-free survival and functional outcomes of buccal mucosa graft urethroplasty in patients with urethral stricture disease after radiotherapy.
MATERIALS AND METHODS: Our urethroplasty database was reviewed for patients with history of radiotherapy undergoing buccal mucosa graft urethroplasty between January 2009 and October 2013. We reviewed patients' charts and institutional standardized non-validated questionnaires administered to each patient following surgery. Endpoints of our study consisted of 1) success rate, 2) continence status, 3) erectile function, 4) patients' satisfaction following surgery. Success rate was defined as stricture-free survival.
RESULTS: Among 38 patients included in the study, prostate cancer was the most common indication for radiotherapy in 35 men (92.1%). External beam radiotherapy was performed in 24 (64.9%), brachytherapy in 8 (21.6%) and a combination thereof in 6 (13.5%). Strictures were located in the bulbar/bulbomembranous urethra and had a median length of 3.0cm (range 1.0 to 8.0). Overall success rate was 71.1% after a median follow-up of 26.5 months (range 1.0 to 50.0). Median time to stricture recurrence was 17.0 months (range 3.0 to 44.0). De-novo urinary incontinence was observed in 4 patients (10.5%). Erectile function remained mostly unchanged compared to preoperative status. Limitations of our study include the small sample size and lack of validated questionnaires.
CONCLUSIONS: In the short- to mid-term follow-up, the success rate of ventral-onlay buccal mucosa graft urethroplasty in patients with radiotherapy history seems acceptable. However, patients need to be counselled about the increased risk of urinary incontinence. Longer follow-up is warranted to address long-term outcomes.
Written by:
Ahyai SA, Schmid M, Kuhl M, Kluth LA, Soave A, Riechardt S, Chun FK, Engel O, Fisch M, Dahlem R. Are you the author?
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Reference: J Urol. 2015 Apr 3. pii: S0022-5347(15)03691-5.
doi: 10.1016/j.juro.2015.03.116
PubMed Abstract
PMID: 25846417