title: Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications.
abstract: OBJECTIVE
  Despite an aging population, the results of urethroplasty in elderly patients have not been extensively reported. We performed a multi-institutional review of urethroplasty results in 70 elderly males to determine outcomes.
  
  
  METHODS
  We reviewed all urethroplasties performed on males older than 64 years with at least 6 months of followup at 4 medical centers. Stricture type varied and included anastomotic urethroplasty (44%), penile fasciocutaneous onlay flap (31%), Johanson urethroplasty (stage 1, 6%, stages 1 and 2, 4%), buccal mucosa grafts (7%), foreskin grafts (6%) and meatoplasty (1%).
  
  
  RESULTS
  Stricture recurred in 11 (16%) patients, but was managed with a single direct visual internal urethrotomy or dilation in 5 of 11 patients, yielding a final success rate of 91%. Recurrent strictures were more common after fasciocutaneous flaps (7 of 22 cases, 32%) than end-to-end urethroplasty (2 of 31 cases, 6%, p <0.05). Compared to patients younger than 65 years there were more treatment failures, but this was not statistically significant. Perioperative complications were uncommon. Moderate bladder outlet obstructive symptoms developed in 3 patients due to benign prostatic hyperplasia. Notably 6 patients treated previously for post-radiation strictures did well without complications.
  
  
  CONCLUSIONS
  Older men tolerate urethroplasty and these data indicate that therapy should not be withheld solely on the basis of age. The potential for impaired flap blood supply in this population is suggested but has not been proven. Benign prostatic hyperplasia must be considered in those patients who have decreased stream after stricture repair.
authors.affiliation: Detroit Receiving Hospital, Detroit, Michigan 48201, USA. rsantucc@med.wayne.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Santucci
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.forename: Layla A
authors.initials: LA
authors.lastname: Mario
authors.forename: Atul
authors.initials: A
authors.lastname: Rajpurkar
authors.forename: Anuj K
authors.initials: AK
authors.lastname: Chopra
authors.forename: Kennon S
authors.initials: KS
authors.lastname: Miller
authors.forename: Noel A
authors.initials: NA
authors.lastname: Armenakas
authors.forename: Edward B
authors.initials: EB
authors.lastname: Tieng
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000209:etiology / Q000601:surgery*