title: The evolution of urethroplasty for bulbar urethral stricture disease: lessons learned from a single center experience.
abstract: OBJECTIVE
  We reviewed the evolution of repairs for bulbar urethral stricture disease and analyzed changes in outcomes.
  
  
  METHODS
  We retrospectively reviewed the records of 429 men who underwent urethroplasty for bulbar urethral stricture disease from January 1996 to September 2011. Patient demographics, stricture related details, and intraoperative and postoperative information were collected. We used 1-way ANOVA for differences in age and stricture length, the Fisher exact test for differences in recurrence rates, and the t-test and chi-square test with the Bonferroni correction for subgroup analysis.
  
  
  RESULTS
  Of the 429 men 384 (90%) had followup data available. Buccal mucosa surpassed penile skin as our preferred tissue for augmented anastomotic repairs by 1999. It was accompanied by an improved recurrence rate (21.6% vs 5.8%, p = 0.002). The average length of strictures treated with excision and primary anastomosis increased after 2004 (1.29 vs 1.54 cm, p = 0.05) but this was not associated with a significant change in the recurrence rate (3.0% vs 6.9%, p = 0.27).
  
  
  CONCLUSIONS
  The transition from penile skin to buccal mucosa for augmented anastomotic repair was relatively abrupt. We have become more aggressive when performing excision and primary anastomosis with respect to stricture length. These changes resulted in improved outcomes. Continuing review of our practices, awareness of results reported by others and intuition contributed to our changes but prospective analysis will be the best way to continually improve outcomes.
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: Michael.Granieri@duke.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Granieri
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: George D
authors.initials: GD
authors.lastname: Webster
authors.affiliation: Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation; D010413:Penis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult
keywords: mouth mucosa; penis; physician's practice patterns; skin transplantation; urethral stricture