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A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

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Abstract
Purpose To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. Methods Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010-2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. Results Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72 years, (IQR 66-75), and 3.0 cm (IQR 2.5-4 cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21 months (IQR 13-40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26 cc,p = 0.001) and Uroflow (4.6 to 15.9 cc/s,p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). Conclusion Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.
Keywords
Urology, Urethral stenosis, Radiation, Buccal mucosa graft, Dorsal onlay, Urethroplasty, URINARY SPHINCTER REVISION, RADIATION-THERAPY, STRICTURES, OUTCOMES, COMPLICATIONS, VIRGIN

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MLA
Policastro, Connor G., et al. “A Multi-Institutional Critical Assessment of Dorsal Onlay Urethroplasty for Post-Radiation Urethral Stenosis.” WORLD JOURNAL OF UROLOGY, 2021, doi:10.1007/s00345-020-03446-y.
APA
Policastro, C. G., Simhan, J., Martins, F. E., Lumen, N., Venkatesan, K., Angulo, J. C., … Nikolavsky, D. (2021). A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis. WORLD JOURNAL OF UROLOGY. https://doi.org/10.1007/s00345-020-03446-y
Chicago author-date
Policastro, Connor G., Jay Simhan, Francisco E. Martins, Nicolaas Lumen, Krishnan Venkatesan, Javier C. Angulo, Shubham Gupta, et al. 2021. “A Multi-Institutional Critical Assessment of Dorsal Onlay Urethroplasty for Post-Radiation Urethral Stenosis.” WORLD JOURNAL OF UROLOGY. https://doi.org/10.1007/s00345-020-03446-y.
Chicago author-date (all authors)
Policastro, Connor G., Jay Simhan, Francisco E. Martins, Nicolaas Lumen, Krishnan Venkatesan, Javier C. Angulo, Shubham Gupta, Paul Rusilko, Erick Alejandro Ramírez Pérez, Kirk Redger, Brian J. Flynn, Michael Hughes, Stephen Blakely, and Dmitriy Nikolavsky. 2021. “A Multi-Institutional Critical Assessment of Dorsal Onlay Urethroplasty for Post-Radiation Urethral Stenosis.” WORLD JOURNAL OF UROLOGY. doi:10.1007/s00345-020-03446-y.
Vancouver
1.
Policastro CG, Simhan J, Martins FE, Lumen N, Venkatesan K, Angulo JC, et al. A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis. WORLD JOURNAL OF UROLOGY. 2021;
IEEE
[1]
C. G. Policastro et al., “A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis,” WORLD JOURNAL OF UROLOGY, 2021.
@article{8688364,
  abstract     = {{Purpose To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. Methods Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010-2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. Results Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72 years, (IQR 66-75), and 3.0 cm (IQR 2.5-4 cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21 months (IQR 13-40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26 cc,p = 0.001) and Uroflow (4.6 to 15.9 cc/s,p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). Conclusion Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.}},
  author       = {{Policastro, Connor G. and Simhan, Jay and Martins, Francisco E. and Lumen, Nicolaas and Venkatesan, Krishnan and Angulo, Javier C. and Gupta, Shubham and Rusilko, Paul and Ramírez Pérez, Erick Alejandro and Redger, Kirk and Flynn, Brian J. and Hughes, Michael and Blakely, Stephen and Nikolavsky, Dmitriy}},
  issn         = {{0724-4983}},
  journal      = {{WORLD JOURNAL OF UROLOGY}},
  keywords     = {{Urology,Urethral stenosis,Radiation,Buccal mucosa graft,Dorsal onlay,Urethroplasty,URINARY SPHINCTER REVISION,RADIATION-THERAPY,STRICTURES,OUTCOMES,COMPLICATIONS,VIRGIN}},
  language     = {{eng}},
  pages        = {{7}},
  title        = {{A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis}},
  url          = {{http://dx.doi.org/10.1007/s00345-020-03446-y}},
  year         = {{2021}},
}

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