title: Improving Outcomes of Bulbomembranous Urethroplasty for Radiation-induced Urethral Strictures in Post-Urolume Era.
abstract: OBJECTIVE
  To evaluate contemporary outcomes of excision and primary anastomosis (EPA) for the treatment of radiation-induced urethral strictures (RUS).
  
  
  METHODS
  A retrospective review of 72 patients undergoing EPA for RUS from 2007 to 2015 by a single surgeon was performed. We analyzed overall and long-term success rates of EPA urethroplasty and compared patient cohorts from two groups, 2007-2012 vs 2013-2015 (post-Urolume).
  
  
  RESULTS
  During the course of the study, we noted a near doubling of patient volume from the earlier (6.2 patients/year) to later (11.7 patients/year) cohorts. Among the 37 men treated from 2007 to 2012, we identified an EPA success rate of 70% compared with the improved 86% success rate in the subsequent cohort of 35 men treated from 2013 to 2015 (P = .07). Single dilation was successful in 50% of initial and 40% of subsequent cohort patients in the treatment of recurrence. Initial and subsequent cohorts varied only in regard to stricture length (mean 2.0 cm vs 3.0 cm in initial and subsequent cohorts, P = .001) and number treated with Urolume stent (initial 5 vs none in the later cohort, P = .03). Length of follow-up (median 50 [17-97] months for the initial and 22 [6-34] months for the later cohort) was not associated with recurrence.
  
  
  CONCLUSIONS
  Increasing numbers of RUS patients are presenting for urethral reconstruction in the post-Urolume era. With increasing experience, we improved success rates of EPA urethroplasty to over 85% despite increased stricture length.
authors: Department of Urology, University of Texas Southwestern, Dallas, TX.
authors: Joceline S
authors: JS
authors: Fuchs
authors: Department of Urology, University of Texas Southwestern, Dallas, TX.
authors: Matthias D
authors: MD
authors: Hofer
authors: Department of Urology, University of Texas Southwestern, Dallas, TX.
authors: Kunj R
authors: KR
authors: Sheth
authors: Department of Urology, University of Texas Southwestern, Dallas, TX.
authors: Billy H
authors: BH
authors: Cordon
authors: Department of Urology, University of Texas Southwestern, Dallas, TX.
authors: Jeremy M
authors: JM
authors: Scott
authors: Department of Urology, University of Texas Southwestern, Dallas, TX. Electronic address: allen.morey@utsouthwestern.edu.
authors: Allen F
authors: AF
authors: Morey
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015179:Colorectal Neoplasms / Q000532:radiotherapy; D003558:Cystoscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011832:Radiation Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000528:radiation effects / Q000601:surgery*; D014525:Urethral Stricture / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*