Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes.

(1) Background: To critically evaluate dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for posterior urethral stenosis repair following transurethral resection and other endoscopic prostate procedures. (2) Methods: A retrospective multi-institutional review of patients with membranous or bulbomembranous urethral stenosis for whom treatment with DOBMGU was conducted after receipt of prostate endoscopic procedures. Baseline data, peri-operative care, post-operative care and patient-reported outcomes were analyzed. The primary outcomes were procedural failure and development of de novo stress urinary incontinence (SUI). The secondary outcomes were changes in voiding, sexual function and patient satisfaction. (3) Results: A total of 107 men with a mean age of 69 ± 9.5 years and stenosis length of 3.5 ± 1.8 cm were included. Prior endoscopic procedures among participants were 47 patients (44%) with monopolar TURP, 33 (30.8%) with bipolar TURP, 16 (15%) with Greenlight laser, 9 (8.4%) with Holmium laser enucleation and 2 (1.9%) with bladder neck incision. At a mean follow-up time of 59.3 ± 45.1 months, stenosis recurred in 10 patients (9.35%). Multivariate analysis confirmed that postoperative complications (OR 12.5; p = 0.009), history of radiation (OR 8.3; p = 0.016) and ≥2 dilatations before urethroplasty (OR 8.3; p = 0.032) were independent predictors of recurrence. Only one patient (0.9%) developed de novo SUI. Patients experienced significant improvement in PVR (128 to 60 cc; p = 0.001), Uroflow (6.2 to 16.8 cc/s; p = 0.001), SHIM (11.5 to 11.7; p = 0.028), IPSS (20 to 7.7; p < 0.001) and QoL (4.4 to 1.7; p < 0.001), and 87 cases (81.3%) reported a GRA of + 2 or better. (4) Conclusions: DOBMGU is an effective and safe option for patients with posterior urethral stenosis following TURP and other prostate endoscopic procedures. This non-transecting approach minimizes external urinary sphincter manipulation, thus limiting postoperative risk of SUI or erectile dysfunction.

Journal of clinical medicine. 2021 Sep 02*** epublish ***

Javier C Angulo, Juan F Dorado, Connor G Policastro, Francisco E Martins, Keith Rourke, Erick A Ramírez, Jay Simhan, Eric S Li, Paul Rusilko, Krishnan Venkatesan, Jonathan N Warner, Jaime Gago, Ignacio Arance, Dmitriy Nikolavsky

Department of Medical Clinic, Faculty of Biomedical Sciences, Universidad Europea de Madrid, 28905 Madrid, Spain., Department of Urology, SUNY Upstate Medical University, Syracuse, NY 13210, USA., Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María, 1649-035 Lisboa, Portugal., Department of Urology, Alberta University, Edmonton, AB T6G 2R3, Canada., Hospital Angeles Mocel, Mexico City 11850, Mexico., Department of Urology, Einstein Medical Center/Fox Chase Cancer Center, Philadelphia, PA 19111, USA., Department of Urology, University of Pittsburgh, Pittsburgh, PA 15260, USA., Urology Department, Georgetown University, Washington, DC 20057, USA., City of Hope Comprehensive Cancer Center, Los Angeles, CA 91010, USA.

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