Postoperative urinary extravasation does not impact anterior urethroplasty surgical outcomes: a Latin American large coh
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UROLOGY - ORIGINAL PAPER
Postoperative urinary extravasation does not impact anterior urethroplasty surgical outcomes: a Latin American large cohort study C. R. Giudice1 · S. A. Gil1 · T. Carminatti1 · E. Becher1 · I. P. Tobia1 · G. A. Favre1 Received: 5 March 2020 / Accepted: 4 May 2020 © Springer Nature B.V. 2020
Abstract Objective To determine the prevalence of postoperative urinary extravasation (POUE) following anterior urethroplasty, to analyze factors associated with its occurrence, and to study the impact of POUE on surgical success. Materials and methods Retrospective cohort study including all male patients who have undergone a urethroplasty at our center between 2011 and 2018. Subjects with posterior location stricture, those who did not undergo routine radiographic follow-up, or patients with inadequate follow-up were excluded. Urinary extravasation was defined as presence of evident contrast extravasation on the postoperative voiding cystourethrogram (VCUG). Impact was determined as “need-for-reoperation”. Uni- and multivariate analysis were performed to determine clinical and demographic variables associated with occurrence of extravasation and postoperative stricture. Results A total of 783 men underwent a urethroplasty and 630 fulfilled inclusion criteria. Urinary extravasation prevalence was 12.2%, and there was a “need-for-reoperation” in 1.1% of cases. On uni- and multivariate analysis, greatest stricture length (HR: 1.07 (1–1.2), p = 0.05) and penile urethral location (HR: 2.29 (1.1–4.6), p = 0.021) showed to be POUE predictors. POUE did not show to be a risk factor for postoperative stricture (HR: 1.57, 95% CI (0.8–3), p = 0.173). However, reoperation group showed to be a risk factor (HR: 6.6, 95% CI 1.4–31, p = 0.019). Conclusions Prevalence of POUE was 12.2%. Stricture length and penile urethral strictures were POUE predictors. POUE occurrence with successful conservative management did not appear to have impact on urethroplasty outcomes as it did not predict re-stricture. POUE was reoperation cause in 1.1% of total cases. Keywords Urethra · Urethral stricture · Anterior urethroplasty · Urinary extravasation
Introduction Urethral strictures are maladies with great quality of life impact [1], and some series report incidences as high as 0.6% [2]. Urethroplasty reported success rates are close to 90% [3, 4], so it is considered the standard of care for urethral strictures management [5]. Same as any other surgical procedure, urethroplasties are not free of postoperative complications [6]. Some series report that the risk of postoperative complications range between 5 and 19% (depending on the type of reconstruction) [7, 8]. The wide list of post-urethroplasty complications * S. A. Gil [email protected] 1
include urinary tract infections (UTI), hematoma, woundsite or graft/flap site-related complications, stricture relapse, and development of a postoperative urinary extravasation (POUE)[9]. The risk of developing a POUE after a urethroplasty varies between 2.2 and 33% depen
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