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Internal urethrotomy in patients with recurrent urethral stricture after buccal mucosa graft urethroplasty

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Abstract

Purpose

To determine the success rate of direct vision internal urethrotomy (DVIU) in the treatment of short stricture recurrence after buccal mucosa graft urethroplasty (BMGU).

Methods

Patients who underwent DVIU for the treatment of short, “veil-like” recurrent urethral strictures (<1 cm) after BMGU between October 2009 and 2013 were retrospectively identified within our urethroplasty database. Stricture recurrence was defined as maximum flow rate (Q max) <15 ml/s and a consecutively verified stricture in a combined retro- and antegrade voiding cystography or cystoscopy at a follow-up visit. The success rate of DVIU was assessed by Kaplan–Meier analysis. Univariable Cox regression analyses evaluated risk factors for stricture recurrence following DVIU.

Results

Forty-three patients underwent DVIU for short stricture recurrence after BMGU for bulbar (81.3 %), penile (14.0 %) and membranous (4.7 %) strictures. Relapse had occurred proximally to the buccal mucosa graft in 28 (65.1 %) and distally in 12 (27.9 %) patients, respectively. At a mean follow-up of 11.7 (±9.7) months, stricture recurrence was observed in 48.8 % of our patients. Stricture recurrence was significantly associated with weak urinary stream (9.3 ml/s vs. no recurrence 19.5 ml/s) and patient dissatisfaction (66.7 % vs. no recurrence 18.1 %; both p < 0.001). The overall success rate was 60.5 % 15 months after DVIU. The main limitations of this study are its retrospective design, the small sample size and the short follow-up.

Conclusions

DVIU after BMGU showed a moderate success rate and therefore might be a viable treatment option in selected patients with very short strictures after BMGU. However, longer follow-up is warranted to prove long-term effectiveness.

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Conflict of interest

Each author declares no conflict of interest.

Ethical standard

All participants of the study provided written informed consent before enrolment, and the study was conducted in accordance with regulatory standards of Good Clinical Practice and the Declaration of Helsinki (1996). Our Institutional Review Board approved the study.

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Authors and Affiliations

  1. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Clemens M. Rosenbaum, Marianne Schmid, Tim A. Ludwig, Luis A. Kluth, Philip Reiss, Roland Dahlem, Oliver Engel, Felix K.-H. Chun, Silke Riechardt, Margit Fisch & Sascha A. Ahyai

Authors
  1. Clemens M. Rosenbaum
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  2. Marianne Schmid
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  3. Tim A. Ludwig
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  4. Luis A. Kluth
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  5. Philip Reiss
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  6. Roland Dahlem
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  7. Oliver Engel
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  8. Felix K.-H. Chun
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  9. Silke Riechardt
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  10. Margit Fisch
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  11. Sascha A. Ahyai
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Corresponding author

Correspondence to Sascha A. Ahyai.

Additional information

Clemens M. Rosenbaum and Marianne Schmid have contributed equally to this work.

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Rosenbaum, C.M., Schmid, M., Ludwig, T.A. et al. Internal urethrotomy in patients with recurrent urethral stricture after buccal mucosa graft urethroplasty. World J Urol 33, 1337–1344 (2015). https://doi.org/10.1007/s00345-014-1450-y

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  • DOI: https://doi.org/10.1007/s00345-014-1450-y

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