title: Long-term followup and deterioration rate of anterior substitution urethroplasty.
abstract: OBJECTIVE
  We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty.
  
  
  METHODS
  We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis.
  
  
  RESULTS
  A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73.8%) were successful and 94 (26.2%) failed, including 91 (96.8%) within the first 5 years. Substitute tissue type (oral mucosa vs skin) was the only significant predictor on univariable analysis (HR 1.86, p = 0.005). This result was confirmed by multivariable analysis adjusting for age at surgery, stricture length and etiology, urethroplasty type and previous treatments (HR 2.26, p = 0.001).
  
  
  CONCLUSIONS
  Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty.
authors.affiliation: Center for Reconstructive Urethral Surgery, Arezzo, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Barbagli
authors.affiliation: Centre for Reconstructive Urology, Pune, India.
authors.forename: Sanjay B
authors.initials: SB
authors.lastname: Kulkarni
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sansalone
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.affiliation: Center for Reconstructive Urethral Surgery, Arezzo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Romano
authors.affiliation: Centre for Reconstructive Urology, Pune, India.
authors.forename: Joshi M
authors.initials: JM
authors.lastname: Pankaj
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Dell'Acqua
authors.affiliation: Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy. Electronic address: lazzeri.maximus@gmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lazzeri
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D052816:Foreskin / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: patient outcome assessment; reconstructive surgical procedures; transplants; treatment failure; urethra