2004 Papers - Vanasupa


Multi-Institutional Review of Partial Urethral Stricture Excision Combined with Flap/Graft Onlay (PECO)

Presented by: Bill P. Vanasupa, CPT, MC1
Bill P. Vanasupa, Urology Service, Department of Surgery, TAMC, Honolulu, HI
Richard S. Stack, Urology Service, Department of Surgery, TAMC, Honolulu, HI
Gerald H. Jordan, Urology Service, Department of Surgery, Eastern Virginia School of Medicine, Norfolk, VA
Allen F. Morey, Urology Service, Department of Surgery, BAMC, San Antonio, TX
Douglas W. Soderdahl, Urology Service, Department of Surgery, DDEAMC, Augusta, GA

Purpose: Successful treatment of bulbous urethral strictures requires a varied armamentarium. Patients with a short stricture length located within the bulbous urethra, excision of the urethral stricture with primary anastomosis (EPA) provides the most favorable long-term result. However, in certain strictures, the combination of excising the most diseased segment with partial primary anastomosis and graft/flap onlay may be beneficial. This technique has been utilized since 1987. Other authors have described this concept as augmented anastomotic urethroplasty. We report the outcomes from four institutions with and without stratification into complicated and uncomplicated cases.

Objective: To determine the success rate of PECO from 4 institutions.

Materials and Methods: We reviewed 47 cases from 1987-2003 from 4 institutions. Patient data were collected for age, stricture location, length and etiology of stricture, onlay tissue type and length, prior procedures, complications, and outcome. A successful outcome is defined as no additional intervention required following PECO. Patients were stratified into uncomplicated or complicated urethral stricture disease. Our criteria for complicated cases include one or more of the following: stricture length exceeding 15 cm, diagnosis of balanitis xerotica obliterans, prior open urethral reconstruction, and history of radiation adjacent to the urethra.

Results: A total of 47 procedures were evaluated. Mean age is 40 years (range 14 to 71). The mean length of follow-up is 30.5 months (range 1-99). Mean stricture length is 7.6 cm (range 2.5 to 22). Multiple etiologies and tissue transfer sources are represented. Overall success rate is 85.1%. Twenty-nine of the 33 (87.9%) uncomplicated cases and 11 of the 14 (78.6%) complicated cases had successful outcomes. The outcome difference between the two groups were not statistically significant (p = 0.41). Overall operative complication rate is 19.1% (9/47).

Conclusions: In this selective group of urethral stricture patients, PECO is shown to be a valuable and durable technique at 30.5 months of follow-up. A statistically significant difference was not observed in outcome analysis based on complicated or uncomplicated criteria. The next level of review will be a multivariate outcome analysis study on a larger patient population to determine if any specific risk factors affect a successful outcome. This information would benefit patient counseling and selection.