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Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results

  • Guido Barbagli
  • Francesco Montorsi
  • Sofia Balò
  • Salvatore Sansalone
  • Carla Loreto
  • Denis Butnaru
  • Vittorio Bini
  • Massimo Lazzeri
Original Article

Abstract

Purpose

We investigated the success rate of different surgical techniques for bulbar stricture repair.

Methods

Retrospective study of patients with bulbar urethral strictures treated using different techniques. The primary outcome of the study was to evaluate the overall results of treatment (success vs. failure); the secondary outcome was to evaluate the outcome according to any surgical technique. Cysto-urethrography was performed 1 month following surgery. Patients underwent clinical evaluation, uroflowmetry and residual urine measurement every 6 months for 2 years after surgery and later once on year. When patient showed obstructive symptoms, Qmax < 12 ml/s, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as failures. A bivariable and multivariable statistical analysis was performed.

Results

Overall, 1242 patients were included in the study with mean age 40 years (range 12–84). Median stricture length was 4 cm (range 1–8). The median follow-up was 103 months (range 12–362). Over 1242 patients, 916 (73.8%) were success and 326 (26.2%) failures. Fourteen different surgical techniques showed a success rate ranging from 87.5 to 14.3%. The multivariable analysis showed that stricture length was an independent predictor factors for failure: p < 0.0001 CI 1146–1509. End–end anastomosis and oral mucosa graft urethroplasty are independent predictor factor of success after internal urethrotomy failure.

Conclusions

Our results showed that treatment of bulbar urethral stricture is satisfactory on 73.8% of patients, but with a wide range of success rate (from 14.3 to 87.5%) using different techniques. Oral mucosa is greatly superior to the skin as substitute material.

Keywords

Urethra Urethroplasty Urethrotomy Surgical technique Oral mucosa Skin graft Long-term results 

Notes

Author contributions

Authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. GB: project development, manuscript writing. FM: project development. SB: data analysis. SS: data analysis. CL: data analysis. DB and VB: data analysis and statistical analysis. ML: project development, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Santucci RA, Joyce GF, Wise M (2007) Male urethral stricture disease. J Urol 177:1667–1674CrossRefGoogle Scholar
  2. 2.
    Waxman SW, Morey AF (2006) Management of urethral strictures. Lancet 367:1379–1380CrossRefGoogle Scholar
  3. 3.
    Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W (2009) Etiology of urethral stricture diseases in the 21st century. J Urol 182:983–987CrossRefGoogle Scholar
  4. 4.
    Andrich DE, Mundy AR (2000) Urethral strictures and their surgical treatment. BJU Int 86:571–580CrossRefGoogle Scholar
  5. 5.
    Wessells H, Angermeier KW, Elliot S et al (2017) Male urethral stricture: America Urological Association Guideline. J Urol 197:182–190CrossRefGoogle Scholar
  6. 6.
    Andrich DE, Dunglison N, Greenwell TJ, Mundy AR (2003) The long-term results of urethroplasty. J Urol 170:90–92CrossRefGoogle Scholar
  7. 7.
    Kessler TM, Schreiter F, Kralidis G, Heitz M, Olianas R, Fisch M (2003) Long-term results of surgery for urethral stricture: a statistical analysis. J Urol 170:840–844CrossRefGoogle Scholar
  8. 8.
    Barbagli G, De Angelis M, Romano G, Lazzeri M (2007) Long-term follow-up of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol 178:2470–2473CrossRefGoogle Scholar
  9. 9.
    Guralnick ML, Webster GD (2001) The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol 165:14961501CrossRefGoogle Scholar
  10. 10.
    Hayes MC, Malone PS (1999) The use of a dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int 83:508–509CrossRefGoogle Scholar
  11. 11.
    Asopa HS, Garg M, Singhal GG, Singh L, Asopa J, Nischal A (2001) Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology 58:657–659CrossRefGoogle Scholar
  12. 12.
    Barbagli G, Pellegrini G, Corradini F et al (2010) One-stage penile urethroplasty using oral mucosal graft and glue. Eur Urol 70:1069–1075CrossRefGoogle Scholar
  13. 13.
    Barbagli G, Selli C, Tosto A, Palminteri E (1996) Dorsal free graft urethroplasty. J Urol 155:123–126CrossRefGoogle Scholar
  14. 14.
    Barbagli G, Selli C, di Cello V, Mottola A (1996) A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. BJU 78:929–932CrossRefGoogle Scholar
  15. 15.
    Barbagli G, Sansalone S, Kulkarni SB, Romano G, Lazzeri M (2012) Surgery illustrated—surgical Atlas. Dorsal onlay oral mucosal graft bulbar urethroplasty. BJU Int 109:1728–1741CrossRefGoogle Scholar
  16. 16.
    Kulkarni S, Barbagli G, Sansalone S, Lazzeri M (2009) One-sided anterior urethroplasty: a new dorsal onlay graft technique. BJU Int 104:1150–1155CrossRefGoogle Scholar
  17. 17.
    Palminteri E, Lazzeri M, Guazzoni G, Turini D, Barbagli G (2002) New 2-stage buccal mucosa graft urethroplasty. J Urol 167:130–132CrossRefGoogle Scholar
  18. 18.
    Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M (2005) Bulbar urethroplasty using bucccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol 174:955–958CrossRefGoogle Scholar
  19. 19.
    Barbagli G, Palminteri E, Lazzeri M, Guazzoni G (2003) One-stage circumferential buccal mucosa graft urethroplasty for bulbous stricture repair. Urology 61:452–455CrossRefGoogle Scholar
  20. 20.
    Wessells H, McAninch JW (1996) Use of free grafts in urethral stricture reconstruction. J Urol 155:1912–1915CrossRefGoogle Scholar
  21. 21.
    Morey AF, McAninch JW (1996) When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology 48:194–198CrossRefGoogle Scholar
  22. 22.
    Morey AF, McAninch JW (1996) Technique of harvesting buccal mucosa for urethral reconstruction. J Urol 155:1696–1697CrossRefGoogle Scholar
  23. 23.
    El-Kassaby AW, El-Zayat TM, Azazy S, Osman T (2008) One-stage repair of long bulbar urethral strictures using augmented Russell dorsal strip anastomosis: outcome of 234 cases. Euro Urol 53:420–424CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Guido Barbagli
    • 1
  • Francesco Montorsi
    • 2
  • Sofia Balò
    • 1
  • Salvatore Sansalone
    • 3
  • Carla Loreto
    • 4
  • Denis Butnaru
    • 5
  • Vittorio Bini
    • 6
  • Massimo Lazzeri
    • 7
  1. 1.Centro Chirurgico ToscanoArezzoItaly
  2. 2.Division of Oncology, Unit of UrologyUrological Research Institute, IRCCS Ospedale San RaffaeleMilanItaly
  3. 3.Department of Experimental Medicine and SurgeryUniversity of Tor VergataRomeItaly
  4. 4.Department of Biomedical and Biotechnological Sciences, Section of Anatomy and HistologyUniversity of CataniaCataniaItaly
  5. 5.Institute for Regenerative MedicineSechenov First Moscow State Medical UniversityMoscowRussia
  6. 6.Department of Internal Medicine and BiostatisticUniversity of PerugiaPerugiaItaly
  7. 7.Department of Urology, Humanitas Clinical and Researcher CenterHumanitas UniversityRozzanoItaly

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