Presentation Authors: Nathan Hoy*, Hadley Wood, Kennneth Angermeier, Cleveland, OH
Introduction: Imaging at the time of urethral foley removal post-urethroplasty is common. Current literature suggests it is unnecessary after excision and primary anastomosis. However, there is less data regarding more complex onlay repairs. Our primary objective is to determine the incidence of extravasation on imaging at time of catheter removal after ventral onlay buccal mucosal graft (BMG) urethroplasty. Secondary objectives include assessing factors that predict extravasation and if extravasation leads to a worsened complication profile and urethroplasty success rate.
Methods: This is a retrospective cohort study of patients who underwent ventral onlay BMG bulbar urethroplasty at our institution from 2007-2017. Patients who had a ventral onlay BMG, with or without an augmented anastomotic urethroplasty (AAU), and imaging at the time of catheter removal were included. All images were reported by a radiologist and reviewed by one of the authors. Urethroplasty success was defined as the ability to pass a 17 French cystoscope at the time of follow-up cystoscopy.
Results: Overall, 229 patients met inclusion criteria â€“ 110 had a ventral onlay BMG and 119 had an AAU with a mean stricture length of 4.4 cm. Post-operative imaging consisted of a voiding cystourethrogram (VCUG) in 210 and retrograde urethrogram (RUG) in 19 at a median 21.7 days after surgery. The incidence of extravasation was 3.1% (7/229). Of patients who had a documented follow-up cystoscopy (60% [137/229]), those who extravasated on imaging (N=7) had a worse urethroplasty success rate (60% [3/5]) compared to those who did not (94% [117/130]) at a mean cystoscopic follow-up of 8.5 months (p=0.047). There was no difference in complication rate between the extravasation (7% [15/229]) and non-extravasation (29% [2/7], p=0.087) groups. On univariate analysis, stricture etiology, post-operative suprapubic tube, days to follow-up imaging, augmented anastomosis, and prior radiation were non-significant predictors of extravasation. On multivariate analysis, those who had 5 or more endoscopic interventions were 9.6 times more likely to demonstrate extravasation on post-operative imaging (OR=9.6, p=0.0080).
Conclusions: The incidence of radiologic extravasation after ventral onlay using BMG, with or without an AAU, is 3.1%. Given this low rate, it is reasonable to omit routine imaging at the time of foley removal after ventral onlay single BMG bulbar urethroplasty. It appears that radiologic extravasation may be associated with a worse cystoscopic patency rate, but does not lead to more complications.