First-stage urethroplasty: utility in the modern era.
OBJECTIVE
To describe the current role of first-stage urethroplasty and its success as a management option in patients with complex anterior urethral stricture disease.


METHODS
We reviewed our urethral stricture database to identify patients managed with a staged urethral reconstruction or permanent first-stage urethroplasty. We noted patient age, etiology of stricture disease, location and length of stricture, location of neomeatus, indication for a staged approach, follow-up, and failure rate.


RESULTS
A total of 38 men with a median age of 53 years met the inclusion criteria. The etiology of stricture disease varied, most commonly prior hypospadias repair (n = 9 [24%]) and lichen sclerosis (n = 6 [16%]). Location of stricture disease varied throughout the anterior urethra. Median stricture length was 5 cm. First-stage urethroplasty was accomplished with a penile shaft neomeatus in 13 patients (34%) and a perineal neomeatus in 25 (66%). Median follow-up was 22 months. Postoperative urethral dilation was required in 7 patients (18%). No patient has required an indwelling urethral catheter, suprapubic cystostomy, or urinary diversion. Of 38 patients, 9 (24%) have undergone a second-stage urethroplasty.


CONCLUSIONS
The first-stage urethroplasty produces unobstructed voiding with few complications in high-risk patients. Few patients elect to have a second-stage urethroplasty performed. This is an old but not obsolete concept. We have presented modifications in technique to optimize success.
Elliott
Sean P
SP
Department of Urology, University of California-San Francisco, San Francisco, California 94110, USA.
Eisenberg
Michael L
ML
McAninch
Jack W
JW
D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods