Login to Access Video or Poster Abstract: MP36-20
Sources of Funding: none

Introduction

Urethral stricture disease related to hypospadias in adults can be challenging surgical problem due to poor quality and paucity of local tissue for repair. We report our experience with staged urethroplasty using buccal mucosal graft in this population.

Methods

Patients who underwent the first of staged urethroplasty using oral mucosa for hypospadias related strictures between 2002 and 2014 at our tertiary referral center were retrospectively reviewed. Patient characteristics, past surgical history, and surgical details were assessed with outcomes, which included complications, revisions, and voiding without obstructive symptoms. Statistical analysis was completed using univariable and multivariable logistic regression models and the Kaplan-Meier method.

Results

Fifty-one patients were identified, with a median follow-up of 17 months (IQR 7-59); 50 patients completed all stages of repair. Median age at the time of first stage urethroplasty was 36 years (IQR 26-49). A majority of patients had penile (38, 75%) or panurethral (12, 24%) strictures. Twenty-four (47%) of patients had subcoronal location of meatus prior to surgery. Following staged repair, 19 (37%) patients and 18 (35%) had subcoronal or orthotopic location of the meatus. Less than half patients (23, 45%) received previous endoscopic procedures. A total of 44 (87%) patients had undergone previous open repair, among these patients, 21 had ?2 prior repairs. Median length of buccal mucosal graft, used in all first stage repairs was 7 cm (IQR: 6-10). At 6 months, the complication rate was 12.5%; all complications in 13 (26%) patients presented by 12 months. 8 (16%) required a revision procedure. A majority of patients (49, 98%) were able to void without obstructive symptoms at median follow-up of 17 months. On multivariable analysis, stricture length, location, number of prior open repairs did not correlate with complications, ability to void without obstructive symptoms, or revisions.

Conclusions

Staged buccal graft urethroplasty demonstrated a high success rate in terms of the ability to void without obstructive symptoms or the need for instrumentation at intermediate follow-up in this challenging cohort of patients. Outcome was not related to stricture length, location, and prior surgical history.

Funding

none