Presentation Authors: Cooper Benson*, New Orleans, LA, Gen Li, Steven Brandes, New York, NY
Introduction: The published literature on anterior augmentation urethroplasty (AU) consists largely of retrospective series from urethral reconstruction experts reporting intermediate follow up. The &[Prime] true &[Prime]long term outcomes of AU however, are incompletely characterized. Many reconstructive surgeons quote interim success rate around 85% and prior systematic reviews report 83%-90% success rates for AU. We sought to summarize and resolve uncertainty as to the long-term success of AU in published series, using statistical methods.
Methods: A systematic pubmed and EMBASE review was performed consistent with PRISMA guidelines to characterize long-term outcomes of single stage AU with a minimum upper range of 100 months of follow. Penile/preputial skin flaps and graft onlay and oral mucosal graft urethroplasties were included. The primary outcome was stricture free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU assuming survival followed an exponential distribution and fixed and random effect models were fitted to the data. A subset analysis removing studies including lichen sclerosus, hypospadias and penile skin graft was also performed.
Results: For the meta-analysis, ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948 (95% CI 0.933-0.964), at 5 years 0.766 (95% CI 0.706-0.831), at 10 years 0.587 (95% CI 0.499-0.691), and at 15 years are 0.45 (95% CI 0.352-0.574). (Figure 1). Subset analysis of the 4 select studies noted 1, 5, 10, and 15 year survival rates of 0.97, 0.96, 0.74, and 0.63 respectively.
Conclusions: The long-term success rates of AU are worse than previously appreciated, with progressive decline in success over time and by quoting intermediate follow up over states and over-estimates long term success. Even in the best case scenarios, eliminating lichen sclerosus, hypospadias failures and penile skin graft AU the 15 year success rate was 63%, and thus patients should be counseled accordingly.