title: Internal urethrotomy in patients with recurrent urethral stricture after buccal mucosa graft urethroplasty.
abstract: OBJECTIVE
  To determine the success rate of direct vision internal urethrotomy (DVIU) in the treatment of short stricture recurrence after buccal mucosa graft urethroplasty (BMGU).
  
  
  METHODS
  Patients who underwent DVIU for the treatment of short, "veil-like" recurrent urethral strictures (<1 cm) after BMGU between October 2009 and 2013 were retrospectively identified within our urethroplasty database. Stricture recurrence was defined as maximum flow rate (Q max) <15 ml/s and a consecutively verified stricture in a combined retro- and antegrade voiding cystography or cystoscopy at a follow-up visit. The success rate of DVIU was assessed by Kaplan-Meier analysis. Univariable Cox regression analyses evaluated risk factors for stricture recurrence following DVIU.
  
  
  RESULTS
  Forty-three patients underwent DVIU for short stricture recurrence after BMGU for bulbar (81.3 %), penile (14.0 %) and membranous (4.7 %) strictures. Relapse had occurred proximally to the buccal mucosa graft in 28 (65.1 %) and distally in 12 (27.9 %) patients, respectively. At a mean follow-up of 11.7 (±9.7) months, stricture recurrence was observed in 48.8 % of our patients. Stricture recurrence was significantly associated with weak urinary stream (9.3 ml/s vs. no recurrence 19.5 ml/s) and patient dissatisfaction (66.7 % vs. no recurrence 18.1 %; both p < 0.001). The overall success rate was 60.5 % 15 months after DVIU. The main limitations of this study are its retrospective design, the small sample size and the short follow-up.
  
  
  CONCLUSIONS
  DVIU after BMGU showed a moderate success rate and therefore might be a viable treatment option in selected patients with very short strictures after BMGU. However, longer follow-up is warranted to prove long-term effectiveness.
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Rosenbaum
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.forename: Tim A
authors.initials: TA
authors.lastname: Ludwig
authors.forename: Luis A
authors.initials: LA
authors.lastname: Kluth
authors.forename: Philip
authors.initials: P
authors.lastname: Reiss
authors.forename: Roland
authors.initials: R
authors.lastname: Dahlem
authors.forename: Oliver
authors.initials: O
authors.lastname: Engel
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.forename: Silke
authors.initials: S
authors.lastname: Riechardt
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Ahyai
mesh_terms: D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014554:Urination / Q000502:physiology*; D014567:Urography; D013521:Urologic Surgical Procedures, Male / Q000379:methods*