title: Assessment of the Male Urethral Reconstruction Learning Curve.
abstract: OBJECTIVE
  To evaluate the urethroplasty learning curve. Published success rates of urethral reconstruction for urethral stricture disease are high even though these procedures can be technically demanding. It is likely that success rates improve with time although a learning curve for urethral reconstruction has never been established.
  
  
  METHODS
  We retrospectively reviewed anterior urethroplasties from a prospectively maintained multi-institutional database. Success was analyzed at the 18-month mark in all patients and defined as freedom from secondary operation for stricture recurrence. A multivariate logistic regression was performed for outcomes vs time from fellowship and case number.
  
  
  RESULTS
  A total of 613 consecutive cases from 6 surgeons were analyzed, with a functional success rate of 87.3%. The success rate for bulbar urethroplasties was higher than that for penile urethroplasties (88.2% vs 78.3%, P = .0116). The success rate of anastomotic repairs was higher than that for substitution repairs (95.0% vs 82.4%, P = .0001). There was a statistically significant trend toward improved outcomes with increasing number of cases (P = .0422), which was most pronounced with bulbar repairs. There was no statistical improvement in penile repairs over time. The case number to reach proficiency (>90% success) was approximately 100 cases for all types of reconstruction and 70 cases for bulbar urethroplasty. There were statistical differences in success rates among the participating surgeons (P = .0014). Complications decreased with time (P = .0053).
  
  
  CONCLUSIONS
  This study shows that success rates of anterior urethral reconstruction improve significantly with surgeon experience. Proficiency occurs after approximately 100 cases.
authors.affiliation: Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Sarah F
authors.initials: SF
authors.lastname: Faris
authors.affiliation: Division of Urology, University of Utah, Salt Lake City, UT.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.affiliation: Department of Urology, University of Washington, Seattle, WA.
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Department of Urology, University of California, San Francisco, CA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.affiliation: Department of Urology, Lahey Clinic, Burlington, MA.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
authors.affiliation: Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Tam
authors.affiliation: Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, IA. Electronic address: brad-erickson@uiowa.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
mesh_terms: D006801:Humans; D059032:Learning Curve; D008297:Male; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data