Abstract: PD29-04
Sources of Funding: None

Introduction

No data exists regarding the frequency of de novo stress urinary incontinence (SUI) in patients with an intact bladder neck who undergo excision and primary anastomotic (EPA) urethroplasty for radiation-induced urethral stenoses (RIUS). We identified the risk for SUI in RIUS patients with urethral stenoses between the membranous and mid-prostatic urethra. A secondary aim was to compare the incidence of SIU to patients with pelvic fracture urethral injuries (PFUI) following EPA urethroplasty.

Methods

Patients who underwent successful EPA urethroplasty between 2008-2016 were reviewed. Only patients with a history of RIUS from prostate cancer or PFUI from blunt trauma were included. Patients at risk for developing SUI were excluded: open bladder neck on pre-operative fluoroscopy, bladder neck dissection during urethroplasty, prior bladder neck surgery (robotic, open, or endoscopic prostate surgery), urinary tract fistula, failed prior posterior urethroplasty, or SUI at baseline. SUI was defined by patient reported outcome measures and subjective complaints. Cystoscopy was performed to assess for anatomic success of urethroplasty._x000D_

Results

Of the total 135 patients, 47% (36/77) of RIUS and 57% (33/58) of PFUI met the inclusion criteria. Among the RIUS cohort, mean follow up was 18 months and mean stricture length was 2.5 cm. Radiated urethral strictures involved the prostatic urethra in 67% (24/36), and surgical scar excision beyond the prostate apex was necessary in 56% (20/36). The overall incidence of de novo SUI among RIUS patients was 33% (12/36). Among those with de novo SUI, 75% (9/12) had prostatic urethral involvement and 50% (6/12) required dissection beyond the prostate apex. For RIUS patients, 2/12 (17%) underwent artificial urinary sphincter (AUS) placement while the remaining 10 patients reported a mean use of 2.3 pads per day (range 1-4). SUI following urethroplasty in PFUI patients was less common (12%, 4/33). One PFUI patient underwent AUS placement while the remaining 3 patients did not report use of pads.

Conclusions

Among RIUS patients with an intact bladder neck, SUI is common following excision of scar in the prostatic urethra, affecting a third of the patients. SUI is less common among PFUI patients, likely related to more a reliable stricture location at the bulbomembranous urethra.

Funding

None