title: A Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures.
abstract: OBJECTIVE
  To evaluate the treatment options and surgical outcomes of long-segment urethral strictures-a review of the largest, international, multi-institutional series.
  
  
  METHODS
  A retrospective review was performed of patients treated with strictures ≥8 cm at 8 international centers. Endpoints analyzed included surgical complications and recurrence.
  
  
  RESULTS
  Four hundred sixty-six patients were identified. Treatment intervals ranged from December 27, 1984 to November 9, 2013. Dorsal onlay buccal mucosal graft (BMG) was the most common procedure (223, 47.9%); others included first- and second-stage Johanson urethroplasty (162 [34.8%] and 56 [12%], respectively), fasciocutaneous (FC) flaps (8, 1.7%), and a combination flap and graft (17, 3.6%). Overall success was achieved in 361 patients (77.5%) with a mean follow-up of 20 months. Second-stage Johanson urethroplasty was found to have a higher recurrence rate compared with that of 1-stage BMG urethroplasty (35.7% vs 17.5%, respectively; P <.01). This was also true in cases of lichen sclerosus (14.0% vs 47.8%, respectively; P <.01). Otherwise, success rates were similar. Urethroplasties performed with FC flaps had a higher complication rate compared with those without (32% vs 14%, respectively; P = .02). Prior dilation or urethrotomy, higher number of prior dilations or urethrotomies, abnormal voiding cystourethrogram, and skin grafts all portend a higher recurrence rate. On logistic regression analysis, only second-stage Johanson had an increased odds ratio of recurrence compared with that of BMG (2.82 [1.41-5.86]).
  
  
  CONCLUSIONS
  Long-segment strictures can be treated with high success rates in experienced hands. BMG was more successful than second-stage Johanson urethroplasty. FC flaps, although successful, had high complication rates.
authors: Department of Urology, University of Michigan, Ann Arbor, MI. Electronic address: jonathan.n.warner@gmail.com.
authors: Jonathan N
authors: JN
authors: Warner
authors: Department of Urology, Detroit Medical Center, Detroit, MI.
authors: Ibraheem
authors: I
authors: Malkawi
authors: Department of Urology, Detroit Medical Center, Detroit, MI.
authors: Mohammad
authors: M
authors: Dhradkeh
authors: Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India.
authors: Pankaj M
authors: PM
authors: Joshi
authors: Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India.
authors: Sanjay B
authors: SB
authors: Kulkarni
authors: Department of Urology, Centro Chirurgico Toscano, Arezzo, Italy.
authors: Massimo
authors: M
authors: Lazzeri
authors: Department of Urology, Centro Chirurgico Toscano, Arezzo, Italy.
authors: Guido
authors: G
authors: Barbagli
authors: Department of Urology, Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Ryan
authors: R
authors: Mori
authors: Department of Urology, Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors: Kenneth W
authors: KW
authors: Angermeier
authors: Department of Urology, Hospital del Trabajador, Santiago, Chile.
authors: Oscar
authors: O
authors: Storme
authors: Department of Urology, Hospital del Trabajador, Santiago, Chile.
authors: Rodrigo
authors: R
authors: Campos
authors: Department of Urology, Hospital del Trabajador, Santiago, Chile.
authors: Laura
authors: L
authors: Velarde
authors: Department of Urology, Hospital del Trabajador, Santiago, Chile.
authors: Reynaldo G
authors: RG
authors: Gomez
authors: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Justin S
authors: JS
authors: Han
authors: Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Christopher M
authors: CM
authors: Gonzalez
authors: Department of Urology, University of Lisbon School of Medicine, Santa Maria Hospital, Lisbon, Portugal.
authors: David
authors: D
authors: Martinho
authors: Department of Urology, University of Lisbon School of Medicine, Santa Maria Hospital, Lisbon, Portugal.
authors: Anatoliy
authors: A
authors: Sandul
authors: Department of Urology, University of Lisbon School of Medicine, Santa Maria Hospital, Lisbon, Portugal.
authors: Francisco E
authors: FE
authors: Martins
authors: Department of Urology, Detroit Medical Center, Detroit, MI.
authors: Richard A
authors: RA
authors: Santucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000473:pathology / Q000601:surgery*; D055815:Young Adult