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Risk calculator for prediction of treatment-related urethroplasty failure in patients with penile urethral strictures

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

To design a dedicated risk calculator for patients with penile urethra stricture who are scheduled to urethroplasty that might be used to counsel patients according to their pre-operative risk of failure.

Methods

Patients treated with penile urethroplasty at our center (1994–2018) were included in the study. Patients received 1-stage or staged penile urethroplasty. Patients with failed hypospadias repair, lichen sclerosus or incomplete clinical records were excluded. Treatment failure was defined as any required postoperative instrumentation, including dilation. Univariable Cox regression identified predictors of post-operative treatment failure and Kaplan–Meier analysis plotted the failure-free survival rates according to such predictors. Multivariable Cox regression-based risk calculator was generated to predict the risk of treatment failure at 10 years after surgery.

Results

261 patients met the inclusion criteria. Median follow-up was 113 months. Out of 216 patients, 201 (77%) were classified as success and 60 (23%) failures. Former smoker (hazard ratio [HR] 2.12, p = 0.025), instrumentation-derived stricture (HR 2.55, p = 0.006), and use of grafts (HR 1.83, p = 0.037) were predictors of treatment failure. Model-derived probabilities showed that the 10-year risk of treatment failure varied from 5.8 to 41.1% according to patient’s characteristics.

Conclusions

Long-term prognosis in patients who underwent penile urethroplasty is uncertain. To date, our risk-calculator represents the first tool that might help physicians to predict the risk of treatment failure at 10 years. According to our model, such risk is largely influenced by the etiology of the stricture, the use of graft, and patient’s smoking habits.

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Abbreviations

QoL:

Quality of life

BMI:

Body mass index

FHR:

Failed hypospadias repair

LS:

Lichen sclerosus

RUG:

Retrograde urethrogram

VCUG:

Voiding cystourethrogram

PVR:

Post-void residual

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Centro Chirurgico Toscano, Arezzo, Italy

    Guido Barbagli & Sofia Balò

  2. Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy

    Marco Bandini, Nicola Fossati & Francesco Montorsi

  3. Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy

    Salvatore Sansalone

  4. Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russia

    Denis Butnaru

  5. Department of Urology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy

    Massimo Lazzeri

Authors
  1. Guido Barbagli
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  2. Marco Bandini
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  3. Sofia Balò
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  4. Nicola Fossati
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  6. Salvatore Sansalone
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Corresponding author

Correspondence to Marco Bandini.

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Electronic supplementary material

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11255_2020_2397_MOESM1_ESM.jpg

Supplementary Figure 1. Retrograde urethrogram showing narrow, irregular, and not distensible penile urethral lumen suggesting extensive scar tissue, and staged repair (JPG 61 kb)

11255_2020_2397_MOESM2_ESM.jpg

Supplementary Figure 2 A, B, C. First-stage urethroplasty. The new-meatus is located at a different site from the balanic sulcus to the base of the penis, according to the stricture length (JPG 70 kb)

11255_2020_2397_MOESM3_ESM.jpg

Supplementary Figure 3. Two-stage oral mucosa graft. A: the urethra is ventrally opened according to Johanson's procedure. Six to nine months later the second stage is performed. B: the urethral plate is incised longitudinally to create a wide bed for the graft location. C: the oral graft is fixed to the distal urethral and the glue is injected. D: the oral graft is moved over the glue bed and pressed for 45 seconds. E: the oral graft is well fixed and distend on the urethral plate. F: the penile skin margins are incised. G: the urethra is closed. H: the penile skin is sutured (JPG 394 kb)

11255_2020_2397_MOESM4_ESM.jpg

Supplementary Figure 4. Retrograde urethrogram showing wide and non-obliterative penile urethral lumen suggesting limited scar tissue, and a one-stage repair (JPG 461 kb)

11255_2020_2397_MOESM5_ESM.jpg

Supplementary Figure 5. One-stage oral mucosa graft. A: the site of penile stricture and of the perineal incision are marked. B: the penis is pushed into the perineum and the penile stricture site is marked. C: the penile urethra is opened and the strictured area is marked. D: the urethral plate is longitudinally incised. E: the oral graft is fixed onto the bed of the dorsal urethrotomy using Glubran glue. F: the urethra is closed. G: the penis is stretched on his original position. H: the perineal opening is sutured (JPG 302 kb)

11255_2020_2397_MOESM6_ESM.jpg

Supplementary Figure 6. One-stage penile skin flap urethroplasty. A: the penile skin flap is marked. B: the skin flap is based on dartos fascia. C: the urethra is dissected from the corpora cavernosa. D: the dorsal urethral surface is exposed and fully opened. E: the penile skin flap is over the corpora cavernosa. F: the margin of skin flap is sutured the margin of the urethral mucosa, Foley 12 F. silicone grooved catheter is inserted and the urethra plate is rotated over the skin flap. G: At the end of the procedure the skin flap is completely covered by the urethra. H: the penile skin incision is closed (JPG 516 kb)

11255_2020_2397_MOESM7_ESM.xlsx

Supplementary File 1: Risk Calculator. The latter was developed from the multivariable Cox-regression model using variables’ coefficients and time-dependent risk ratios of treatment failure. Outcome was set at 10 years of follow-up after surgery (XLSX 17 kb)

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Barbagli, G., Bandini, M., Balò, S. et al. Risk calculator for prediction of treatment-related urethroplasty failure in patients with penile urethral strictures. Int Urol Nephrol 52, 1079–1085 (2020). https://doi.org/10.1007/s11255-020-02397-y

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  • DOI: https://doi.org/10.1007/s11255-020-02397-y

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