title: Outcomes of reintervention after failed urethroplasty.
abstract: OBJECTIVE
  Urethroplasty is a procedure that has a high success rate. However, there exists a small subgroup of patients who require multiple procedures to achieve an acceptable result. This study analyses the outcomes of a series of patients with failed urethroplasty.
  
  
  METHODS
  This is a retrospective review of 82 failures out of 407 patients who underwent urethroplasty due to urethral stricture during the period 1999-2013. Failure was defined as the need for an additional surgical procedure. Of the failures, 26 patients had penile strictures and 56 had bulbar strictures. Meatal strictures were not included.
  
  
  RESULTS
  The redo procedures included one or multiple direct vision internal urethrotomies, dilatations or new urethroplasties, all with a long follow-up time. The patients underwent one to seven redo surgeries (mean 2.4 procedures per patient). In the present series of patients, endourological procedures cured 34% (28/82) of the patients. Ten patients underwent multiple redo urethroplasties until a satisfactory outcome was achieved; the penile strictures were the most difficult to cure. In patients with bulbar strictures, excision with anastomosis and substitution urethroplasty were equally successful. Nevertheless, 18 patients were defined as treatment failures. Of these patients, nine ended up with clean intermittent self-dilatation as a final solution, five had perineal urethrostomy and four are awaiting a new reintervention. Complicated cases need centralized professional care.
  
  
  CONCLUSIONS
  Despite the possibility of needing multiple reinterventions, the majority of patients undergoing urethroplasty have a good chance of successful treatment.
authors.affiliation: a Department of Urology , Sahlgrenska University Hospital, Institute of Clinical Sciences at Sahlgrenska Academy , Gothenburg , Sweden.
authors.forename: Teresa Olsen
authors.initials: TO
authors.lastname: Ekerhult
authors.affiliation: a Department of Urology , Sahlgrenska University Hospital, Institute of Clinical Sciences at Sahlgrenska Academy , Gothenburg , Sweden.
authors.forename: Klas
authors.initials: K
authors.lastname: Lindqvist
authors.affiliation: a Department of Urology , Sahlgrenska University Hospital, Institute of Clinical Sciences at Sahlgrenska Academy , Gothenburg , Sweden.
authors.forename: Ralph
authors.initials: R
authors.lastname: Peeker
authors.affiliation: a Department of Urology , Sahlgrenska University Hospital, Institute of Clinical Sciences at Sahlgrenska Academy , Gothenburg , Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Grenabo
mesh_terms: D002648:Child; D002675:Child, Preschool; D004106:Dilatation; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery; D014525:Urethral Stricture / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*
keywords: Clean intermittent self-dilatation; direct vision internal urethrotomy; perineal urethrostomy; reintervention; urethral stricture; urethroplasty