Presentation Authors: Gregory Murphy*, Saint Louis, MO, Kirk Fergus, San Francisco, CA, Thomas Gaither, Los Angeles, CA, Nima Baradaran, Columbus, OH, Bryan Voelzke, Seattle, WA, Jeremy Myers, Salt Lake City, UT, Bradley Erickson, Iowa City, IA, Sean Elliott, Minneapolis, MN, Nejd Alsikafi, Chicago, IL, Alex Vanni, Burlington, MA, Jill Buckley, San Diego, CA, Benjamin Breyer, San Francisco, CA
Introduction: Perineal urethrostomy is a viable option for many complex urethral strictures; however, no comparison with anterior urethroplasty (AU) or complex AU regarding patient reported outcome measures (PROMs) has been published. We sought to compare these groups using a large multi-institution database.
Methods: A retrospective study of AU in the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) database was performed. The AU cohort was subdivided into 2 groups of complex and non-complex AU. The complex AU cohort was defined by a stricture > 8cm or an etiology of lichen sclerosus (LS). We compared demographic, clinical, urinary and sexual characteristics using validated PROMs.
Results: 1090 patients with non-complex AU, 127 with complex AU and 70 patients with perineal urethrostomy met inclusion criteria (Table 1). Cumulative incidence of failure at 2 years was 8.67% for non-complex AU, 29.23% for complex AU and 15.86% for perineal urethrostomy (p < 0.001) (Figure 1). There was no difference in any of the post operative PROM metrics between the non-complex AU and perineal urethrostomy groups (Table 2). However, complex AU patients had worse PROMs in all 4 metrics. Compared to baseline metrics, patients with non-complex AU, complex AU and perineal urethrostomy had improved urinary function but similar sexual function after surgery.
Conclusions: Patients report improvement in urinary function after perineal urethrostomy with no deleterious effect on sexual function. These PROMs are comparable with non-complex AU and better then complex AU outcomes. Perineal urethrostomy failure rates were higher than non-complex AU but lower than complex AU.