title: Assessment of Wound Complications After Bulbar Urethroplasty: The Impact of a Lambda Perineal Incision.
abstract: OBJECTIVE
  To analyze risk factors for wound-specific complications after bulbar urethroplasty, including the association between incision type and complications.
  
  
  METHODS
  This is a retrospective review of 829 urethroplasties excluding penile strictures, incomplete data sets, and radiation-induced urethral stenosis. Ninety-day wound complications were reported using the modified Clavien-Dindo classification of postoperative complications. Risk factors for wound complications were evaluated using univariable and multivariable analysis: patient age, positive preoperative urine culture, Charlson comorbidity index ≥ 2, diabetes, body mass index ≥ 35, smoking, and incision type (lambda perineal incision [LPI] vs. midline perineal incision [MPI]).
  
  
  RESULTS
  Five hundred forty patients met inclusion criteria; 373 patients with an LPI and 167 patients with an MPI. Ninety-day wound complications (any Clavien grade) occurred in 21% of patients. Multivariable analyses indicated that incision type alone was significantly associated with wound complications (multivariable: MPI OR 0.53 (0.34-0.83), P = .01). The majority of complications were Clavien ≤ 2, which occurred in 23.3% (87 patients) of LPIs compared to 11.9% (20 patients) of MPIs (P = .002). The primary difference between the incisions was superficial wound edge separation (LPI 10.7% [40 patients]; MPI 0%, P  <  .0001). Early (6-month) urethroplasty success favored the midline incision (LPI 6.2% vs MPI 0%, P  =  .0003), implying no obvious technical advantage for the lambda incision. Study limitations include a retrospective design and the use of some patient-reported complication outcomes.
  
  
  CONCLUSIONS
  An LPI is independently associated with increased 90-day wound complications after urethroplasty, with no identifiable advantage in urethroplasty outcome.
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bascom
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Fairey
authors.affiliation: Division of Urology, Department of Surgery, 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; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*