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Urethroplasty after Transurethral Resections of the Prostate: A Multi-Institutional Report
Kevin Yang, MD1, Bryan B. Voelzke, MD2, Sean P. Elliott, MD3, Jeremy B. Myers, MD4, Christopher D. McClung, MD5, Benjamin N. Breyer, MD6, Alex J. Vanni, MD1.
1Lahey Hospital & Medical Center, Burlington, MA, USA, 2University of Washington, Seattle, WA, USA, 3University of Minnesota, Minneapolis, MN, USA, 4University of Iowa, Iowa City, IA, USA, 5Ohio State University Wexner Medical Center, Columbus, OH, USA, 6University of California, San Francisco, CA, USA.

BACKGROUND: Urethral strictures after transurethral resection of the prostate (TURP) occur in up to 10% of patients. Large-scale studies regarding optimal reconstructive management are lacking. We performed a multi-institutional evaluation of urethral stricture location and reconstructive outcomes for post-TURP strictures.
METHODS: A retrospective review of a multi-institutional, prospectively maintained reconstructive urologic database was performed from 2008-2014 to identify patients with post-TURP urethral strictures who underwent subsequent urethroplasty. The ability to pass a 17-Fr cystoscope defined operative success. Subjective quality of life questionnaires were recorded.
RESULTS: We identified 43 patients from 7 surgeons who underwent urethral reconstructions after TURP. 33 had complete follow-up data. Mean age and stricture length were 62.3 years and 4.27 cm (range 1 to 20 cm). Stricture location was as follows: membranous or bulbomembranous (27%); bulbar (21%); bulbopendulous (18%); penile (24%); fossa navicularis (3%); panurethral (6%). Repair type varied on location and included substitution with buccal graft, excision and primary anastomosis (EPA) and fasciocutaneous flap. 28 patients (85%) had success with a mean follow-up of 10.9 months. 5 failures were reported and included three ventral onlay, one dorsal onlay and one EPA repair. There were no reported changes in the IPSS, CLSS, SHIM, MSHQ scores or continence status (p > 0.05).
CONCLUSIONS:
Successful reconstruction of post-TURP urethral strictures requires a variety of techniques depending on stricture location. Continence seems to be preserved in patients with bulbomembranous strictures. Further studies will be necessary to determine the optimal approach for these strictures.
Stricture locations, lengths and repair type
Stricture LocationMean LengthOperative Repair
Bulbomembranous
(n = 9, 27%)
2.72 cm
(range 1 to 4 cm)
Substitution urethroplasty with ventral onlay (n = 5)
Excision and primary anastomosis (n = 4)
Bulbar
(n = 7, 21%)
1.97 cm
(range 1 to 4 cm)
Substitution urethroplasty with ventral onlay (n = 3)
Excision and primary anastomosis (n = 3)
Augmented dorsal anastomotic repair (n = 1)
Bulbopendulous
(n = 6, 18%)
5.13 cm
(range 1.75 to 13 cm)
Substitution urethroplasty with dorsal onlay (n = 4)
Substitution urethroplasty with ventral onlay (n = 1)
Excision and primary anastomosis (n = 1)
Penile
(n = 8, 24%)
4.66 cm
(range 1.5 to 12 cm)
Fasciocutaneous flap (n = 4)
Substitution urethroplasty with dorsal onlay (n = 2)
Substitution urethroplasty with ventral onlay (n = 1)
Augmented dorsal anastomotic repair (n = 1)
Fossa navicularis
(n = 1, 3%)
1.5 cmFasciocutaneous flap (n = 1)
Panurethral
(n = 2, 6%)
16.5 cm
(range 13 to 20 cm)
Substitution urethroplasty with dorsal onlay (n = 1)
Two staged repair (n = 1)


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