title: Revision urethroplasty success is comparable to primary urethroplasty: a comparative analysis.
abstract: OBJECTIVE
  To assess the efficacy and complications of revision urethroplasty compared with urethroplasty-naïve controls.
  
  
  METHODS
  A retrospective analysis was performed of 534 urethroplasties performed by a single surgeon from August 2003 to March 2011. Patient age, stricture length, location, etiology, comorbidities, and type of surgery were recorded. Statistical comparison between the revision cohort and urethroplasty-naïve group were made using Fisher, χ(2), and unpaired t tests, with significance at P < .05 (2-tailed). The primary outcome was urethral patency assessed by cystoscopy. Secondary (subjective) outcome measures included erectile dysfunction, pain, urinary tract infection, or chordee at 6 months.
  
  
  RESULTS
  A total of 476 patients met inclusion criteria with completed cystoscopic follow-up. Previous urethroplasty had failed in 49 patients (10.3%). Patients undergoing revision urethroplasty were more likely to have stricture in the penile urethra (22.4%; P = .001), to have strictures exceeding 4 cm in length (71.4% vs 54.3%; P = .023), and to require tissue transfer (83.6% vs 65.1%; P = .010). Urethral patency rates did not differ significantly between naïve and revision urethroplasty cohorts, with a mean follow-up of 49.9 months (94.6% vs 91.8%; P = .518). The revision group had a higher incidence of chordee (2.7% vs 14.3%; P = .001) and urinary tract infection (3.5% vs 10.2%; P = .04). The rates of erectile dysfunction, scrotal pain, lower urinary tract symptoms, and incontinence did not differ significantly between the 2 groups.
  
  
  CONCLUSIONS
  Revision urethroplasty is an effective treatment option for recurrent stricture after urethroplasty and is comparable to results in urethroplasty-naïve patients. Patients undergoing revision urethroplasty are more likely to require tissue transfer and experience higher rates of chordee and urinary tract infection.
authors.affiliation: Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Max A
authors.initials: MA
authors.lastname: Levine
authors.affiliation: Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kinnaird
authors.affiliation: Division of Urology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: krourke@ualberta.ca.
authors.forename: Keith F
authors.initials: KF
authors.lastname: Rourke
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012086:Reoperation; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods