Presentation Authors: Robert Kovell*, Philadelphia, PA, Susan MacDonald, Hershey, PA, Allison Rasper, Lexington, KY, Alex Skokan, Philadelphia, PA, David Kurz, Toms River, NJ, Rohit Ajmera, Ajmer, India, Ryan Terlecki, Winston Salem, NC
Introduction: American urologists are increasingly attempting to deliver sub-specialty care to areas lacking critical resources. Although surgical feasibility is demonstrated at the time of service, subsequent outcomes data are not well represented in the literature to confirm durability. We aim to assess the outcomes of urethral reconstruction performed as part of an ongoing satellite mission in an underserved area of India and to evaluate whether our efforts are accomplishing the desired effect for the local population.
Methods: All cases of urethral reconstruction performed at JLN Medical College (Ajmer, Rajasthan) by our team of American urologists were reviewed. Data was extracted for patient demographics, stricture characteristics, and nature of repair. All follow-up was conducted by the local team per established protocol. Planned radiographic follow-up consisted of pericatheter urethrogram and voiding cystourethrogram at 3 and 4 weeks for all anastomotic and substitution urethroplasties, respectively.
Results: From 2016-2017, 40 consecutive cases of urethral reconstruction or perineal urethrostomy were identified. Median follow-up was 7 (6-12) months. Median age was 40.5 (8-76) years. Stricture length ranged from 1.5-14cm. Cases involved single stage substitution (19; 14 buccal grafts, 4fasciocutaneous flaps, 1 combination graft+flap), excision and primary anastomosis (10), staged repair (5), perineal urethrostomy (2), and posterior repair (4). Pre-operatively, 31/40(78%) were dependent on suprapubic tubes (SPT) for bladder drainage. 39/40 (98%) returned for post-operative imaging and had their urethral catheters removed after demonstrated lack of contrast extravasation. All SPTs subsequently were removed between 4-8 weeks following repeat uroflow testing. All 39(100%) were voiding via urethra at 6 month follow-up visit. 2/39 (5.1%) were found to have meatal stenosis away from the repair site requiring dilation. No other urethral procedures were required. No high grade (Clavien 3 or above) complications were reported. Of note, the host institution's urology department has increased their volume of independently performed urethroplasties following each outreach.
Conclusions: At short term follow-up, outcomes of remotely performed urethral reconstruction in the setting of limited resources appear promising despite a complex, heterogeneous population. Future efforts will determine the longevity of success and predictive factors, as well as the impact of surgical education upon subsequent performance of urethral surgery by local physicians.