Buccal mucosal graft urethroplasty for radiation-induced urethral strictures: an evaluation using the extended Urethral
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ORIGINAL ARTICLE
Buccal mucosal graft urethroplasty for radiation‑induced urethral strictures: an evaluation using the extended Urethral Stricture Surgery Patient‑Reported Outcome Measure (USS PROM) Malte W. Vetterlein1 · Luis A. Kluth2 · Valentin Zumstein1,3 · Christian P. Meyer1 · Tim A. Ludwig1 · Armin Soave1 · Silke Riechardt1 · Oliver Engel1 · Roland Dahlem1 · Margit Fisch1 · Clemens M. Rosenbaum1,4 · for the Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists Received: 19 November 2019 / Accepted: 21 January 2020 © The Author(s) 2020
Abstract Objectives To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiationinduced urethral strictures undergoing single-stage urethroplasty. Patients and methods Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan–Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM). Results Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65–74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28–68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome. Conclusion The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly. Keyword Lower urinary tract symptoms · Patient satisfaction · Quality of life · Radiotherapy · Urinary incontinence Malte W. Vetterlein and Luis A. Kluth contributed equally. Members of the Trauma and Reconstructive Urology Working Party of the European Association of Urology (EAU) Young Academic Urologists (YAU): Luis A. Kluth, Clemens M. Rosenbaum. * Malte W. Vetterlein [email protected] 1
Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr.
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