Multi-institutional 1-year bulbar urethroplasty outcomes using a standardized prospective cystoscopic follow-up protocol.
OBJECTIVE
To evaluate multi-institutional outcomes of bulbar urethroplasty utilizing a standardized cystoscopic follow-up protocol.


METHODS
Eight reconstructive surgeons prospectively enrolled urethral stricture patients in a multi-institutional study and performed postoperative cystoscopy at 3 and 12 months. Anatomic failure was defined as the inability to pass a flexible cystoscope without force. Functional failure was defined as the need for a secondary procedure. Men not compliant with the 12-month cystoscopy were called and asked if any interval secondary procedures had been performed. Patients with bothersome voiding complaints at cystoscopy were considered symptomatic.


RESULTS
Of 213 men in study, 136 underwent excisional urethroplasty (excision and primary anastomosis [EPA]) and 77 underwent repair with buccal grafts. Cystoscopy compliance was 79.8% at 3 months and 54.4% at 12 months. Anatomic success rates were higher at 3 vs 12 months for EPA repairs (97.2% [106 of 109] vs 85.5% [65 of 76; P=.003] but not buccal repairs (85.5% [53 of 62] vs 77.5% [31 of 40]; P=.30). Functional success rates at a year were higher but statistically similar to anatomical success rates (EPA-90.3% [93 of 103]; P=.33; buccal-87% [47 of 54]; P=.22). Of the 20 anatomic recurrences, only 13 (65%) were symptomatic at the time of cystoscopic diagnosis.


CONCLUSIONS
Rates of success are lower when using the anatomic vs traditional definition. Of recurrences found by cystoscopy, only 65% were symptomatic. One-year patient cystoscopy compliance was poor and its ability to be used as the gold standard screening methodology for recurrence is questionable.
Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: brad-erickson@uiowa.edu.
Bradley A
BA
Erickson
Department of Urology, University of Minnesota, Minneapolis, MN.
Sean P
SP
Elliott
Department of Urology, University of Washington, Seattle, WA.
Bryan B
BB
Voelzke
Division of Urology, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT; Department of Urology, Kansas University Medical Center, Kansas City, KS.
Jeremy B
JB
Myers
Department of Urology, Kansas University Medical Center, Kansas City, KS.
Joshua A
JA
Broghammer
Department of Urology, Baylor College of Medicine, Houston, TX.
Thomas G
TG
Smith
Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH.
Chris D
CD
McClung
Department of Urology, Stritch School of Medicine, Loyola University Chicago Medical Center, Maywood, IL.
Nejd F
NF
Alsikafi
Division of Urology, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT; Department of Urology, Kansas University Medical Center, Kansas City, KS.
William O
WO
Brant
D002985:Clinical Protocols; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*