A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis
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ORIGINAL ARTICLE
A multi‑institutional critical assessment of dorsal onlay urethroplasty for post‑radiation urethral stenosis Connor G. Policastro1 · Jay Simhan2 · Francisco E. Martins3 · Nicolaas Lumen4 · Krishnan Venkatesan5,6 · Javier C. Angulo7 · Shubham Gupta8 · Paul Rusilko9 · Erick Alejandro Ramírez Pérez10 · Kirk Redger11 · Brian J. Flynn11 · Michael Hughes1 · Stephen Blakely1 · Dmitriy Nikolavsky1 Received: 25 July 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. Methods Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010–2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. Results Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72 years, (IQR 66–75), and 3.0 cm (IQR 2.5–4 cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21 months (IQR 13–40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26 cc, p = 0.001) and Uroflow (4.6 to 15.9 cc/s, p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). Conclusion Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty. Keywords Urethral stenosis · Radiation · Buccal mucosa graft · Dorsal onlay · Urethroplasty
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03446-y) contains supplementary material, which is available to authorized users. 6
MedStar Washington Hospital Center, Washington, DC, USA
7
Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY 13210, USA
Departemento Clinico, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
8
Case West
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