Presentation Authors: Stella Ivaz*, Simon Bugeja, Anastasia Frost, Nikki Jeffrey, Angelica Lomiteng, Mariya Dragova, Daniela E Andrich, Anthony R Mundy, London, United Kingdom
Introduction: This study evaluates the outcome of redo-urethroplasty in patients with recurrent penile, bulbar or posterior urethral strictures with a particular view to identifying any factors constituting complexity and any difference in the outcome of revisional surgery on the three different anatomic segments of the urethra.
Methods: Over a ten year period, 51 redo-bulbar, 133 redo-penile and 48 redo-posterior urethroplasties following pelvic trauma (PFUI) were perfomed in a single unit. Minimum follow-up was five years. Patients were followed up clinically (and by PROMS in the latter part of the study), radiologically and by flow rate assessment.
Results: The restricture rate for redo-bulbar urethroplasty was 4% (3.5% for primary surgery) with the recurrence rate increasing significantly in patients having had 3 or more previous urethroplasties. 18.8% of revisional penile urethroplasty recurred (10% in primary surgery). Recurrence was commonest in salvage hypospadias surgery (15 of 80 procedures; 18.8%). For bulbar and penile redo-urethroplasty, the revision surgery commonly involved a more complex procedure than the primary (e.g required a buccal graft when the primary procedure was a simple anastomotic; performed as a staged procedure when the primary was single-staged). Following redo-urethroplasty for PFUI, the recurrence rate was 12.5% (5.4% in primary surgery). The redo-procedure was usually further down the "step-wise progression" approach (more commonly requiring inferior pubectomy and/or rerouting of the urethra) than the primary failed procedure. The median time to stricture recurrence for all revision surgery was three months.
Conclusions: Bulbar urethroplasty has the best results both for primary and revisional surgery even when the revision is more complicated. Redo surgery is well tolerated.Penile urethroplasty has less satisfactory results; is technically more demanding and has many more complicating factors especially in redo surgery â€“ which is not well tolerated.Posterior urethroplasty for trauma also has a number of complicating factors and is technically more demanding especially in redo surgery. This emphasises the importance of a successful primary intervention in these cases.