BERKELEY, CA (UroToday.com) - During the past decade, a shift has occurred in all surgical fields toward performing more outpatient surgery and for the use of procedures that minimize the overall impact of surgery on the patient. Shorter procedure times, better analgesia techniques, and improved preparation of the patient often allows patients to leave the hospital within a few hours even after invasive surgery. Urethroplasty has proven to be an effective, successful treatment of urethral stricture disease with little morbidity. Traditionally, patients undergoing urethroplasty are admitted to the hospital for 1 to 3 days after surgery.

A recent review from M. F. MacDonald and R. A. Santucci presents an evaluation of the safety and feasibility of decreasing the impact of anterior urethroplasty by minimizing surgery time, maximizing adjuvant pain therapy, and preparing patients for a discharge to home the same day as their urethral reconstruction. In a retrospective review published in the October 2005 issue of Urology, the records of 54 consecutive patients undergoing anterior urethroplasty were reviewed and examined for length of hospital stay, complications, readmissions, and stricture recurrences.

A closer look at the study group revealed that 34 patients underwent an anastomotic or end-to-end urethroplasty and 20 underwent ventral onlay buccal mucosa graft urethroplasty. In an attempt to allow for same day surgery, all patients had general anesthetics using newer inhaled agents such as desflurane and intravenous agents such as diprivan to allow for faster recovery from anesthesia. Patients were also given subcutaneous injection of a long-acting local anesthetic (bupivicaine) to the surgical incision at the time of closure and oral Celebrex upon awakening. Ice was used to the surgical site intermittently for 24 hours. Surgery time was generally less than 2 hours for an anastomotic urethroplasty and less than 3 hours for a buccal mucosa onlay urethroplasty.

Analysis of the review showed that 37 of the 54 patients (69%) were able to be discharged home the day of surgery. This percentage increased over time with the increasing comfort level of the surgeon. During the last 32 months of the study, 85% of patients were able to undergo outpatient urethroplasty. Only patients with minimal comorbidities were considered for outpatient urethroplasty. Outpatient urethroplasty was defined as being sent home within 4 hours after entering the post anesthesia care unit. The admitted patients had comparable stricture length as the say day group, and the choice of urethroplasty (anastomotic versus substitution) did not matter. The admitted group was slightly older (49 years versus 42 years).

The incidence of early and late complications was similar between the two groups. No readmissions or emergency room visits occurred in either group. Success rate were also comparable between the two groups. In summary, decreasing the impact of urethroplasty surgery allows for safe early discharge for most patients. The authors continue to plan for admission only for those extremely elderly patients, those with severe comorbidities, and those expected to undergo lengthy (longer than 5 hours) surgery.

Urology. 2005 Oct; 66(4):850-853