Abstract: PD34-12
Sources of Funding: none

Introduction

While repeat urethroplasty following primary treatment failure is often successful, limited data exist describing outcomes among men requiring additional urethral surgeries. We aim to describe the characteristics and outcomes among men undergoing tertiary urethroplasty compared to primary and secondary repairs.

Methods

A retrospective review of over 1000 urethroplasty cases by a single surgeon from 2007-2014 was performed to identify men undergoing primary, secondary, and tertiary urethroplasty procedures. Tertiary urethroplasty was defined as urethral reconstruction following two or more previous urethroplasty failures. Clinical characteristics and outcomes were compared between groups. Mutivariable logistic regression models evaluated the association between number of previous urethral surgeries and treatment success.

Results

Among 573 urethroplasty cases having complete data available, 46 (8%) tertiary procedures were compared with 87 (15%) secondary and 440 (77%) primary procedures. Tertiary strictures were more often located in the penile urethra (50% vs 29% vs 17%, p<0.0001), and underwent substitution urethroplasty (61% vs 41% vs 23%, p<0.0001). Failure rates were higher for tertiary cases (37%) vs 20% and 13 % for secondary and primary procedures (p=0.0001) during follow up (mean 17 months). The estimated 24-month stricture recurrence-free survival was lower for tertiary cases (44% vs 75% vs 75%, p=0.07), but success rates of perineal urethrostomy (100%) and excision primary anastomosis (90%) were far greater than substitution urethroplasty (50%). Tertiary repairs were more likely to have a history of hypospadias (58% vs 20% vs 2%, p<0.001) and chronic kidney disease (17% vs 5% vs 9%, p=0.003). No difference was noted in age, medical comorbidities, nor frequency of <90 day complications. On multivariable analysis controlling for history of hypospadias, stricture location, and type of surgery, tertiary urethroplasty was associated with an increased risk of treatment failure relative to primary (OR 2.88, 95%CI 1.29-6.65; p=0.02) and secondary (OR 2.11, 95%CI 0.87-5.14; p=0.09) urethroplasty.

Conclusions

While tertiary urethroplasty is associated with an increased risk of treatment failure relative to primary and secondary urethroplasty, many patients can expect to experience durable resolution of obstructive voiding symptoms.

Funding

none