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Surgical Reconstruction of Failed Anterior Urethroplasty

  • Adam Miller
  • Allen F. Morey
  • Boyd R. ViersEmail author
Chapter

Abstract

Urethroplasty has proven to be a cost-effective first-line treatment option for urethral stricture disease. In contemporary series, long-term success rates exceed 90% for anastomotic techniques and 85% for substitution urethroplasty. Urethroplasty failure can often be successfully salvaged with a subsequent reconstructive procedure, the success rates of which approach 80% employing various novel reconstructive techniques.

Keywords

Urethroplasty Reoperative Urethral stricture 

References

  1. 1.
    Eltahawy EA, et al. Long-term followup for excision and primary anastomosis for anterior urethral strictures. J Urol. 2007;177(5):1803–6.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Levine MA, Kinnaird AS, Rourke KF. Revision urethroplasty success is comparable to primary urethroplasty: a comparative analysis. Urology. 2014;84(4):928–32; quiz 932–3.PubMedGoogle Scholar
  3. 3.
    Levy M, et al. The impact of age on urethroplasty success. Urology. 2017;107:232–8.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Whitson JM, et al. Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease. J Urol. 2008;179(6):2259–64.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Barbagli G, et al. Long-term followup and deterioration rate of anterior substitution urethroplasty. J Urol. 2014;192(3):808–13.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Morey AF, Duckett CP, McAninch JW. Failed anterior urethroplasty: guidelines for reconstruction. J Urol. 1997;158(4):1383–7.PubMedGoogle Scholar
  7. 7.
    Dalpiaz O, et al. Single-stage dorsal inlay split-skin graft for salvage anterior urethral reconstruction. BJU Int. 2008;101(12):1565–70.PubMedGoogle Scholar
  8. 8.
    Joseph JV, et al. Urethroplasty for refractory anterior urethral stricture. J Urol. 2002;167(1):127–9.PubMedGoogle Scholar
  9. 9.
    O’Riordan A, et al. Outcome of dorsal buccal graft urethroplasty for recurrent bulbar urethral strictures. BJU Int. 2008;102(9):1148–51.PubMedGoogle Scholar
  10. 10.
    Blaschko SD, et al. Repeat urethroplasty after failed urethral reconstruction: outcome analysis of 130 patients. J Urol. 2012;188(6):2260–4.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Breyer BN, et al. Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol. 2010;183(2):613–7.Google Scholar
  12. 12.
    Siegel JA, et al. Repeat excision and primary anastomotic urethroplasty for salvage of recurrent bulbar urethral stricture. J Urol. 2015;194(5):1316–22.PubMedGoogle Scholar
  13. 13.
    Chapman D, Kinnaird A, Rourke K. Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures. J Urol. 2017;198(5):1107–12.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Spencer J, et al. Hypoandrogenism is prevalent in males with urethral stricture disease and is associated with longer strictures. Urology. 2018;114:218–23.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Hofer MD, et al. Low testosterone levels result in decreased periurethral vascularity via an androgen receptor-mediated process: pilot study in urethral stricture tissue. Urology. 2017;105:175–80.PubMedGoogle Scholar
  16. 16.
    Hofer MD, Morey AF. Role of androgens for urethral homeostasis. Transl Androl Urol. 2018;7(4):521–5.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Viers BR, et al. Geriatric urethroplasty: lessons learned from urethral reconstruction in elderly men. J Urol. 2017;197(4):e1187.Google Scholar
  18. 18.
    Viers BR, et al. Urethral reconstruction in aging male patients. Urology. 2018;113:209–14.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Viers BR, et al. Delayed reconstruction of bulbar urethral strictures is associated with multiple interventions, longer strictures and more complex repairs. J Urol. 2018;199(2):515–21.PubMedGoogle Scholar
  20. 20.
    Rourke KF, Jordan GH. Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol. 2005;173(4):1206–10.PubMedGoogle Scholar
  21. 21.
    Culty T, Boccon-Gibod L. Anastomotic urethroplasty for posttraumatic urethral stricture: previous urethral manipulation has a negative impact on the final outcome. J Urol. 2007;177(4):1374–7.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Roehrborn CG, McConnell JD. Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol. 1994;151(4):869–74.PubMedGoogle Scholar
  23. 23.
    Viers BR, et al. Characteristics of idiopathic urethral strictures: a link to remote perineal trauma? Urology. 2017;110:228–33.Google Scholar
  24. 24.
    Lumen N, et al. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182(3):983–7.Google Scholar
  25. 25.
    Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002;167(4):1715–9.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Sukumar S, et al. Multi-institutional outcomes of endoscopic management of stricture recurrence after bulbar urethroplasty. J Urol. 2018;200(4):837–42.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Erickson BA, Breyer BN, McAninch JW. The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. J Urol. 2010;184(4):1386–90.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Erickson BA, Breyer BN, McAninch JW. Changes in uroflowmetry maximum flow rates after urethral reconstructive surgery as a means to predict for stricture recurrence. J Urol. 2011;186(5):1934–7.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Johnson EK, Latini JM. The impact of urethroplasty on voiding symptoms and sexual function. Urology. 2011;78(1):198–201.PubMedGoogle Scholar
  30. 30.
    Morey AF, et al. American urological association symptom index in the assessment of urethroplasty outcomes. J Urol. 1998;159(4):1192–4.PubMedGoogle Scholar
  31. 31.
    Hoy NY, et al. Incidence and predictors of complications due to urethral stricture in patients awaiting urethroplasty. J Urol. 2018;199(3):754–9.PubMedGoogle Scholar
  32. 32.
    Voelzke BB. Critical review of existing patient reported outcome measures after male anterior urethroplasty. J Urol. 2013;189(1):182–8.PubMedGoogle Scholar
  33. 33.
    Warren GJ, Erickson BA. The role of noninvasive testing and questionnaires in urethroplasty follow-up. Transl Androl Urol. 2014;3(2):221–6.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Belsante MJ, et al. Cost-effectiveness of risk stratified followup after urethral reconstruction: a decision analysis. J Urol. 2013;190(4):1292–7.PubMedGoogle Scholar
  35. 35.
    Barbagli G, Selli C, Tosto A. Reoperative surgery for recurrent strictures of the penile and bulbous urethra. J Urol. 1996;156(1):76–7.PubMedGoogle Scholar
  36. 36.
    Pagliara T, et al. PD34-12 tertiary urethroplasty: is the third time a charm? J Urol. 2017;197(4):e661–2.Google Scholar
  37. 37.
    Rosenbaum CM, et al. Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and functional outcomes. BJU Int. 2016;118(5):797–803.PubMedGoogle Scholar
  38. 38.
    McLaughlin MD, et al. Buccal mucosal urethroplasty in patients who had multiple previous procedures. Urology. 2006;68(6):1156–9; discussion 1159.PubMedGoogle Scholar
  39. 39.
    Kessler TM, Ryu G, Burkhard FC. Clean intermittent self-catheterization: a burden for the patient? Neurourol Urodyn. 2009;28(1):18–21.PubMedGoogle Scholar
  40. 40.
    Lubahn JD, et al. Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol. 2014;191(1):143–7.PubMedGoogle Scholar
  41. 41.
    Armenakas NA, Morey AF, McAninch JW. Reconstruction of resistant strictures of the fossa navicularis and meatus. J Urol. 1998;160(2):359–63.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Patel CK, et al. Outcomes for management of lichen sclerosus urethral strictures by 3 different techniques. Urology. 2016;91:215–21.PubMedGoogle Scholar
  43. 43.
    Morey AF, et al. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatotomy (first stage Johanson) maneuver. J Urol. 2007;177(1):184–7; discussion 187.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Barbagli G, et al. Clinical outcome and quality of life assessment in patients treated with perineal urethrostomy for anterior urethral stricture disease. J Urol. 2009;182(2):548–57.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Myers JB, Porten SP, McAninch JW. The outcomes of perineal urethrostomy with preservation of the dorsal urethral plate and urethral blood supply. Urology. 2011;77(5):1223–7.PubMedGoogle Scholar
  46. 46.
    Orandi A. One-stage urethroplasty. Br J Urol. 1968;40(6):717–9.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Quartey JK. One-stage penile/preputial cutaneous island flap urethroplasty for urethral stricture: a preliminary report. J Urol. 1983;129(2):284–7.PubMedPubMedCentralGoogle Scholar
  48. 48.
    McAninch JW, Morey AF. Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol. 1998;159(4):1209–13.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Simonato A, et al. The tongue as an alternative donor site for graft urethroplasty: a pilot study. J Urol. 2006;175(2):589–92.PubMedGoogle Scholar
  50. 50.
    Song LJ, et al. Lingual mucosal grafts for anterior urethroplasty: a review. BJU Int. 2009;104(8):1052–6.PubMedGoogle Scholar
  51. 51.
    Xu YM, et al. Oral complications after lingual mucosal graft harvesting for urethroplasty in 110 cases. BJU Int. 2011;108(1):140–5.PubMedGoogle Scholar
  52. 52.
    Palmer DA, et al. Urethral reconstruction with rectal mucosa graft onlay: a novel, minimally invasive technique. J Urol. 2016;196(3):782–6.Google Scholar
  53. 53.
    Hudak SJ, et al. Single-stage reconstruction of complex anterior urethral strictures using overlapping dorsal and ventral buccal mucosal grafts. BJU Int. 2012;110(4):592–6.PubMedGoogle Scholar
  54. 54.
    Shakir NA, et al. Excision and primary anastomosis reconstruction for traumatic strictures of the pendulous urethra. Urology. 2018;125:234–8.PubMedGoogle Scholar
  55. 55.
    Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach – what are the limits? J Urol. 2006;175(6):2145–9; discussion 2149.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Terlecki RP, et al. Grafts are unnecessary for proximal bulbar reconstruction. J Urol. 2010;184(6):2395–9.PubMedGoogle Scholar
  57. 57.
    Barbagli G, et al. Dorsal free graft urethroplasty. J Urol. 1996;155(1):123–6.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Vasudeva P, et al. Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: a prospective randomized study. Int J Urol. 2015;22(10):967–71.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol. 2001;165(5):1496–501.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Coursey JW, et al. Erectile function after anterior urethroplasty. J Urol. 2001;166(6):2273–6.PubMedGoogle Scholar
  61. 61.
    Myers JB, McAninch JW. Surgery illustrated – surgical atlas: perineal urethrostomy. BJU Int. 2011;107:856–65.PubMedGoogle Scholar
  62. 62.
    Parker DC, Morey AF, Simhan J. 7-flap perineal urethrostomy. Transl Androl Urol. 2015;4(1):51–5.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of UrologyMayo ClinicRochesterUSA
  2. 2.Department of UrologyUniversity of Texas SouthwesternDallasUSA

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