Presented by: Kapilan Ravichandran
Toowoomba Hospital

Introduction

Complex urethral strictures, such as panurethral strictures, hypospadias, and double face urethroplasty, present unique challenges in terms of management and successful treatment outcomes. Despite their clinical significance, there is a lack of comprehensive data and studies specifically focusing on the outcomes of urethroplasty for these complex cases. This study aims to address this knowledge gap by evaluating the outcomes of urethroplasty for complex urethral strictures at a regional Australian center.

Materials

A retrospective chart review was conducted on all patients who underwent complex urethroplasty for panurethral strictures, hypospadias, and double face urethroplasty between August 2017 to January 2023. Patient demographics, technique and outcomes were analysed utilising descriptive statistics.

Results

,

A total of 33 patients underwent complex urethroplasty, accounting for 16% of the unit's overall workload (n=206). Among these patients, 7 had panurethral strictures, all of which were treated using the buccal mucosal graft dorsal onlay technique. Additionally, 12 patients underwent double face urethroplasty (including 1 female patient), while 14 patients had hypospadias (8 dorsal inlay, 4 Johansson procedures, 1 ventral inlay, and 1 preputial skin graft). The average age of the patients was 56.14 years, and the mean follow-up period was 13 months.

Prior to undergoing urethroplasty, 21 out of the 33 patients (63%) had experienced failed dilatation treatment, and 8 patients (24%) had undergone previous urethroplasty. The outcomes observed in this study were consistent with the existing literature. Recurrence of strictures was noted in 1 patient with a panurethral stricture, 1 patient who had undergone double face urethroplasty, and 1 patient who had undergone hypospadias repair. Notably, a history of previous urethroplasty (100% of cases) was identified as a significant risk factor for stricture recurrence with the double face technique. The maximum flow rate (Qmax) showed an improvement of 96% at 3 months following the procedure.

In terms of subjective patient satisfaction with urinary tract symptoms, it was reported to be 90% at 3 months, 82% at 6 months, and 75% at 12 months post-urethroplasty. These findings indicate favorable outcomes and highlight the positive impact of complex urethroplasty in improving patients' quality of life and managing their urinary tract symptoms.

Conclusion

The study results suggest that complex urethroplasty can be successfully performed at a regional center by a fellowship-trained surgeon, with outcomes comparable to those seen in high-volume centers.

Funding

nil

Lead Authors

William Harrison,
Toowoomba Hospital