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The impact of age on transecting vs. non-transecting bulbar urethroplasty
Kristian Stensland, MD1, Mya Levy, MD2, Sean Elliott, MD2, Bradley Erickson, MD3, Jeremy Myers, MD4, Bryan Voelzke, MD5, Thomas Smith, III, MD6, Benjamin Breyer, MD7, Christopher McClung, MD8, Nejd Alsikafi, MD9, Alex Vanni, MD1.
1Lahey Hospital and Medical Center, Burlington, MA, USA, 2University of Minnesota, Minneapolis, MN, USA, 3University of Iowa, Iowa City, IA, USA, 4University of Utah, Salt Lake City, UT, USA, 5University of Washington, Seattle, WA, USA, 6Baylor College of Medicine, Houston, TX, USA, 7University of California San Francisco, San Francisco, CA, USA, 8Ohio State University, Columbus, OH, USA, 9Loyola University, Maywood, IL, USA.

BACKGROUND: A successful transecting bulbar urethroplasty by excision and primary anastomosis (EPA) depends on collateral blood flow. A successful non-transecting bulbar urethroplasty by ventral or dorsal buccal mucosa graft augmentation (BMG) likewise depends on neovascularization of the BMG. Older patients have increased incidence of comorbid conditions including peripheral vascular disease that are associated with reduced penile blood flow. We sought to determine the effect of age on bulbar urethroplasty success in general and, specifically, in transecting vs. non- transecting. METHODS: Bulbar urethroplasties were retrospectively reviewed from 11 institutions that collaborate on a multi-institutional reconstructive urology database (TURNS). We limited patients to those with at least 12 months of follow-up after transecting EPA or non-transecting BMG. Our primary outcome was any procedure for re-stricture (dilation, urethrotomy or urethroplasty); our secondary outcome was anatomic success defined by urethral caliber greater than 17 F confirmed by cystoscopy. We compared results stratified by age. RESULTS: In total, 322 patients were included, with 258 patients younger than 60 years and 64 patients older than 60 years. Median follow-up was 1.8 years; there was no difference in follow-up time between the two groups. The following were not statistically significantly different between groups: stricture length, location of stricture, smoking status, number of previous dilations/urethrotomies, and type of urethroplasty. The following comorbidities were statistically significantly more common in the age>60 group: diabetes, hypertension, hyperlipidemia, coronary artery and peripheral vascular disease, chronic obstructive pulmonary disease, and cancer. There was no statistically significant difference between age groups with regard to receipt of repeat procedures or anatomic recurrence, both overall and when stratified by urethroplasty type (Table 1). CONCLUSIONS: Both transecting and non-transecting bulbar urethroplasty can be performed with high success rates regardless of age. This is despite a higher incidence of diabetes, cardiovascular and peripheral vascular disease in the elderly.


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