title: Long-term outcomes of urethroplasty with abdominal wall skin grafts.
abstract: OBJECTIVE
  To report the long-term outcomes of urethroplasty using abdominal wall skin (AWS) grafts. Men with long-segment strictures, prior urethroplasty, and lichen sclerosus (LS) pose challenges in surgical management, including the choice of graft tissue for urethral reconstruction. AWS grafts are an alternative when buccal mucosa or penile grafts are not feasible or chosen by the patient.
  
  
  METHODS
  We retrospectively reviewed 238 patients who underwent urethroplasty (2000-2010) with at least 1 year of follow-up. Demographics, etiology, comorbidities, prior procedures, and surgical technique were analyzed for correlation with recurrence.
  
  
  RESULTS
  Mean age was 42.9 years (range, 15-79 years), mean stricture length 5.6 cm (1-24 cm), and median follow-up of 59.3 months (12.5-147 months). A total of 58.4% patients had prior intervention, of which 15 patients (6.3%) had urethroplasty and 41 patients (17.2%) had hypospadias repair. Twenty-six patients (10.9%) underwent urethroplasty with AWS graft, whereas 107 (45.0%) and 12 (5.0%) patients were augmented with buccal mucosa or genital skin. Sixty-six patients (27.7%) had stricture recurrence at a mean of 34.5 months (range, 1.87-87.1 months). On univariate analysis, patients with AWS graft had longer strictures (P = .0001), were more likely to have LS (P = .0002), prior urethroplasty (P = .007), and recurrence (P = .002). On multivariate analysis, prior urethroplasty (odds ratio [OR], 5.3; P = .009), diabetes (OR, 2.6; P = .04), and LS (OR, 2.8; P = .05) were significantly associated with recurrence, whereas AWS graft was not (OR, 2.0; P = .28).
  
  
  CONCLUSIONS
  AWS grafts are an alternative tissue source for urethral stricture, but may be associated with greater risk of recurrence. This may be secondary to patient selection, with this population often having other risk factors for recurrence.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Joceline S
authors.initials: JS
authors.lastname: Liu
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Justin
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Said
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Hofer
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Amanda
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Ballek
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: cgonzalez@nmff.org.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D018459:Lichen Sclerosus et Atrophicus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014522:Urethral Diseases / Q000601:surgery; D014525:Urethral Stricture / Q000601:surgery*; D055815:Young Adult