Oral Mucosa Grafting (Omg) Or Excision And Primary Anastomosis (Epa) For The Treatment Of Radiation-Associated Urethral Strictures: Comparative Analysis

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-17 ORAL MUCOSA GRAFTING (OMG) OR EXCISION AND PRIMARY ANASTOMOSIS (EPA) FOR THE TREATMENT OF RADIATION-ASSOCIATED URETHRAL STRICTURES: COMPARATIVE ANALYSIS Matthias D. Hofer, Dmitriy Nikolavsky, Connor Policastro, Brian J Flynn, Kirk Redger, Allen F. Morey, Sarah Sanders, Avery Wolfe, Aziz Shaaban, Jay Simhan, Curran Uppaluri, Erick Ramirez, Javier Angulo, Krishnan Venkatesan, Akio Horiguchi, Cooper Benson, Ayman Elmasri, Diana Bowen, Chris M. Gonzalez, Ryan Dornbier, and Francisco E. Martins Matthias D. HoferMatthias D. Hofer More articles by this author , Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author , Connor PolicastroConnor Policastro More articles by this author , Brian J FlynnBrian J Flynn More articles by this author , Kirk RedgerKirk Redger More articles by this author , Allen F. MoreyAllen F. Morey More articles by this author , Sarah SandersSarah Sanders More articles by this author , Avery WolfeAvery Wolfe More articles by this author , Aziz ShaabanAziz Shaaban More articles by this author , Jay SimhanJay Simhan More articles by this author , Curran UppaluriCurran Uppaluri More articles by this author , Erick RamirezErick Ramirez More articles by this author , Javier AnguloJavier Angulo More articles by this author , Krishnan VenkatesanKrishnan Venkatesan More articles by this author , Akio HoriguchiAkio Horiguchi More articles by this author , Cooper BensonCooper Benson More articles by this author , Ayman ElmasriAyman Elmasri More articles by this author , Diana BowenDiana Bowen More articles by this author , Chris M. GonzalezChris M. Gonzalez More articles by this author , Ryan DornbierRyan Dornbier More articles by this author , and Francisco E. MartinsFrancisco E. Martins More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiation-associated strictures occurring after radiotherapy for prostate cancer usually affect the bulbomembranous urethra. These strictures are more challenging to repair and have an increased rate of recurrence. While EPA has traditionally been the preferred surgical repair, the use of OMG for these strictures has been emerging. We analyze both techniques and aim to identify those patients that are better suited for either technique. METHODS: In a multicentric international study we collected 181 patients with radiation-associated strictures of which 75 underwent OMG dorsal onlay and 106 EPA urethroplasties between 2004 and 2020. Mean follow-up was 46.64 months. RESULTS: Three patients were lost to follow-up. 94/178 (52.5%) had been treated with external beam radiation, 57 (31.9%) with brachytherapy, and 27 (15.1%) with a combination of both. Mean stricture length was 2.82 cm. Mean surgical time was 167.5 minutes and mean blood loss 174.5 ml. Overall, 141/175 (80.6%) of patients experienced a durable urethral patency. There was no difference in patient characteristics such as co-morbidities, specifically hypertension, diabetes, or lung disease between OMG and EPA cohorts, and there also no difference in frequency of prior endoscopic interventions or operative parameters such as blood loss or surgical time. Patients treated with OMG patients had significantly longer strictures than those in EPA patients (3.72 vs. 2.14 cm (p<0.001). Notably, there was no difference in post-op parameters such as post-void dribbling, penile pain, or erectile dysfunction. Patients treated with OMG urethroplasty had a significantly lower risk of recurrence (8/69 (11.6%) vs. 26/106 (24.5%) p=0.035) albeit this cohort also had a significantly shorter follow-up (39.1 months vs 51.8; p=0.014). Patients undergoing EPA had a significantly higher risk of recurrence if they had diabetes (p=0.031) or an increased body mass index (BMI, p=0.048) with increased stricture length being associated with recurrence with borderline significance (p=0.053). We found no specific risk factors for recurrence among OMG patients. Dose of radiation did not impact success of either technique. CONCLUSIONS: Both OMG and EPA urethroplasties are very successful in treating radiation-associated urethral strictures. OMG grafting appears to be better suited for patients with longer strictures and those with diabetes and higher BMI, both of which may be associated with decreased urethral perfusion facilitating stricture recurrence after EPA. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e27-e28 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthias D. Hofer More articles by this author Dmitriy Nikolavsky More articles by this author Connor Policastro More articles by this author Brian J Flynn More articles by this author Kirk Redger More articles by this author Allen F. Morey More articles by this author Sarah Sanders More articles by this author Avery Wolfe More articles by this author Aziz Shaaban More articles by this author Jay Simhan More articles by this author Curran Uppaluri More articles by this author Erick Ramirez More articles by this author Javier Angulo More articles by this author Krishnan Venkatesan More articles by this author Akio Horiguchi More articles by this author Cooper Benson More articles by this author Ayman Elmasri More articles by this author Diana Bowen More articles by this author Chris M. Gonzalez More articles by this author Ryan Dornbier More articles by this author Francisco E. Martins More articles by this author Expand All Advertisement Loading ...