Best Practices & Benign Disease
Introduction & Objective : We sought to describe our post-operative complications and stricture recurrence following anterior urethroplasty, and to investigate any correlation between them.
Methods : We retrospectively reviewed patients undergoing anterior urethroplasty at MedStar Washington Hospital Center by a single surgeon. We recorded peri-operative complications and classified them as infectious, anastomotic, voiding, bleeding, oral mucosa related, or non-urologic, including cardiac, pulmonary, hematologic, or other systemic complications. Complications were classified by the Clavien-Dindo system. Recurrence was diagnosed by urethrogram or cystoscopy.
Results : From September 2012 to March 2018, 211 anterior urethroplasties were performed. Mean patient age was 51 years (17-81). Thirty-seven of 211 (17.5%) procedures resulted in post-operative complications. Complications were categorized as infectious (14), anastomotic (7), bleeding (2), voiding (8), related to the oral buccal mucosal graft site (2) or otherwise non-urologic (4). Peno-bulbar urethroplasty had the highest rate of complication (33.3%) however there was no significant difference in complication by location, as demonstrated in Table 1 (p=0.132). Ten procedures (4.7%) resulted in Clavien grade III or higher complication: 3/14 infectious, 1/7 anastomotic, 2/2 bleeding and 3/8 voiding complications. One procedure resulted in mortality due to cardiac arrest on post-operative day one. Complications were not significantly associated with recurrence of stricture (p=0.367). Thirty of 211 (14.2%) procedures resulted in stricture recurrence at a mean 5.7 months (1-22) time to recurrence. As shown in table 1, there was no significant difference in recurrence rates based on urethroplasty location (p=0.402).
Urethroplasty is safe and serious complications are rare; infection is the most common complication. Our results are consistent with prior published rates of complications and recurrence. Complications, while unlikely, should always be included in pre-operative counseling. Fortunately, if they do occur, complications do not appear to portend a greater risk of stricture recurrence.