Presentation Authors: Valentin Zumstein, Roland Dahlem, Clemens M. Rosenbaum, Valentin Maurer, Hamburg, Germany, Luis A. Kluth, Frankfurt (Main), Germany, Margit Fisch, Malte W. Vetterlein*, Hamburg, Germany
Introduction: Outcomes after urethroplasty are often contaminated by heterogeneous study populations and operative techniques. We report outcomes of the largest series of patients who underwent one-stage Asopa dorsal inlay urethroplasty for penile urethral stricture.
Methods: Retrospective study of 137 patients who underwent Asopa urethroplasty for penile stricture between 2009-2016. Patients without follow-up data, a history of radiotherapy or gender reassignment surgery, and those with isolated fossa navicularis/meatal strictures were excluded (N=12). Several characteristics were compared across treatment groups (penobulbar, isolated penile, and distal). Kaplan-Meier curves were plotted to estimate recurrence-free survival. Patient satisfaction was assessed using a validated outcome measurement tool.
Results: Of 125 patients, 38 (30%), 74 (59%), and 13 (10%) had distal, penile, and penobulbar stricture, respectively. Patients with distal strictures were younger and graft length was shorter compared to those with penile or penobulbar stricture (all Pâ‰¤0.009). The majority of strictures were iatrogenic (38%), followed by hypospadias-related (24%), congenital (17%), traumatic (10%), inflammatory (9%), and post-infectious strictures (2.4%). Of all patients, 47 (38%) had a history of prior urethroplasty. Overall, Qmax improved significantly following surgery (preoperative mean 8.8 vs. postoperative 23.3 ml/s; P < 0.001). Median follow-up was 25 months (IQR 7-41) and overall success rate was 70% (88/125 patients). This translated into success rates of 66%, 74%, and 62% for distal, isolated penile, and penobulbar strictures, respectively.Patients with penile strictures were significantly more satisfied compared to those with distal or penobulbar strictures (84% vs. 61% and 69%, respectively; P=0.035). Reasons for dissatisfaction were recurrence (30%), oral morbidity (11%), erectile dysfunction (11%), urgency (3.7%), pain (3.7%), among others (15%).
Conclusions: Success rates of Asopa urethroplasty in penile strictures are lower than previously reported. This is most likely due to adverse stricture etiology, complex surgical history, and last resort one-stage surgery in many patients. Thus, preoperative counseling must consider high recurrence risk and staged urethroplasty should be discussed in select cases to optimize patient satisfaction.