You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) II (PD44)1 May 2024PD44-08 LONG-TERM MORBIDITY ASSOCIATED WITH SURGICAL MANAGEMENT OF UROSYMPHYSEAL FISTULA Alexandr M. Pinkhasov, Jayson Kemble, Anthony E. Fadel, Elizabeth Bearrick, and Boyd R. Viers Alexandr M. PinkhasovAlexandr M. Pinkhasov , Jayson KembleJayson Kemble , Anthony E. FadelAnthony E. Fadel , Elizabeth BearrickElizabeth Bearrick , and Boyd R. ViersBoyd R. Viers View All Author Informationhttps://doi.org/10.1097/01.JU.0001008800.83683.92.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urosymphyseal fistula (USF) is a profoundly debilitating disease process that is characterized by communication between the urinary tract (bladder or prostate) and pubic bone. Curative surgical therapy includes cystectomy with urinary diversion or fistula tract excision with bladder neck reconstruction, pubic bone debridement, and vascularized tissue flap interposition. There is a paucity of scientific literature regarding long-term outcomes for these patients. We aim to identify and characterize factors associated with long-term morbidity of definitive USF treatment. METHODS: Retrospective chart review of a single institution database identified 57 patients who underwent operative treatment of USF between 2009-2022 with>90 days of follow-up. Morbidity related to surgery was assessed up to 10 years postoperatively. Statistical analysis was performed using fishers exact and Mann Whitney-U tests. RESULTS: A total of 57 patients at a median age of 71 years old (IQR 66-75) presented with USF and ultimately underwent open 50 (88%) or robotic 7 (12%) repair. Delayed (>90 d) post operative complications requiring major intervention occurred at a median time of 11 months (IQR 6-18). Twelve (21%) patients required image-guided drain placement, 5 (9%) nephrostomy tubes, and 14 (24%) patients required additional surgery. Hernia was noted in 15 (26%) patients at a median time of 12 months (6-27). The use of omentum, VRAM, or no flap made no difference in hernia occurrence or the type of hernia (p>0.05). Pre-operative albumin of<3.5 mg/dL and the width of pubic bone resection was not associated with hernia formation. A history of tobacco was significant (p=0.05). Recurrent osteomyelitis occurred in 6 (11%) patients at a median of 4.5 months. Patients with recurrent osteomyelitis had smaller width of pubic bone resection (48 mm vs 73 mm, p=0.03). Delayed pelvic abscess formation was more common in patients who did not have flap interposition, 4 of 10 patients (40%), than those who did, 4 of 47 patients (9%) (p=0.03). New or worsening sacral insufficiency (SI) fracture occurred in 14 (25%) patients diagnosed at a median 2.5 months. The width of pubic bone resection was not associated with developing new or worsening SI fracture (p>0.05). Ultimately, long-term pain resolved in 40 (70%), and 49 (86%) men were able to discontinue antibiotic therapy. CONCLUSIONS: While definitive USF repair is associated with long term morbidity including need for reintervention, hernia formation, recurrent infection, and SI fracture, most men are rendered free of infection and have significant improvement of life in quality following surgical treatment. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e908 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexandr M. Pinkhasov More articles by this author Jayson Kemble More articles by this author Anthony E. Fadel More articles by this author Elizabeth Bearrick More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyLower Tract Reconstruction (including Transgender) II (V13)1 May 2024V13-06 RECONSTRUCTIVE ALGORITHM FOR MANAGEMENT OF VESICOURETHRAL ANASTOMOTIC STENOSIS Alexandr M. Pinkhasov, Bridget L. Findlay, Garrett N. Ungerer, Anthony E. Fadel, Katherine T. Anderson, J. Nicholas Warner, and Boyd R. Viers Alexandr M. PinkhasovAlexandr M. Pinkhasov , Bridget L. FindlayBridget L. Findlay , Garrett N. UngererGarrett N. Ungerer , Anthony E. FadelAnthony E. Fadel , Katherine T. AndersonKatherine T. Anderson , J. Nicholas WarnerJ. Nicholas Warner , and Boyd R. ViersBoyd R. Viers View All Author Informationhttps://doi.org/10.1097/01.JU.0001009532.52598.9a.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vesicourethral anastomotic stenosis following radical prostatectomy, and bladder neck contracture following surgical intervention for benign prostatic hyperplasia can have significant quality of life impacts. Mild and index cases can be successfully managed endoscopically; however recurrent or severe cases should be formally reconstructed with minimally invasive robotic techniques. We propose a reconstructive algorithm as an aid in surgical planning. METHODS: A thorough work-up should include retrograde urethrogram, voiding cystourethrogram, cystoscopy, and MRI. RESULTS: Depending on the degree of stenosis several different methods of bladder neck reconstruction can be undertaken. Short segment obliterative strictures can be amenable to excision and primary anastomosis. Patients narrow but not completely obliterated stenosis can undergo YV-plasty if their urethral plate is >8mm. Long segment strictures with a fixed bladder neck may require a downward bladder advancement flap, while strictures that extend through the pelvic floor may require a combined abdominoperineal approach with a urethral pull through. Herein, we present these 4 methods of bladder neck reconstruction. CONCLUSIONS: Utilization of a reconstructive algorithm enables for a successful robotic assisted treatment of recalcitrant vesicourethral anastomotic stenosis. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1157 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexandr M. Pinkhasov More articles by this author Bridget L. Findlay More articles by this author Garrett N. Ungerer More articles by this author Anthony E. Fadel More articles by this author Katherine T. Anderson More articles by this author J. Nicholas Warner More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making II (MP24)1 May 2024MP24-12 PRACTICE TRENDS OF EARLY CAREER UROLOGIC ONCOLOGISTS Anthony E. Fadel, Elizabeth Bearrick, Bridget L. Findlay, Ekamjit S. Deol, R. Houston Thompson, Timothy D. Lyon, Douglas A. Husmann, Boyd Viers, and Vidit Sharma Anthony E. FadelAnthony E. Fadel , Elizabeth BearrickElizabeth Bearrick , Bridget L. FindlayBridget L. Findlay , Ekamjit S. DeolEkamjit S. Deol , R. Houston ThompsonR. Houston Thompson , Timothy D. LyonTimothy D. Lyon , Douglas A. HusmannDouglas A. Husmann , Boyd ViersBoyd Viers , and Vidit SharmaVidit Sharma View All Author Informationhttps://doi.org/10.1097/01.JU.0001008860.46052.c4.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Practice patterns of early career urologic oncologists are not well characterized. Herein, the goal of our study is to utilize the American Board of Urology (ABU) case logs to define practice patterns of urologic oncology trained fellowship graduates to characterize changes in these patterns by practice type (academic vs private practice) and surgeon gender (male vs female). METHODS: ABU case logs were utilized to identify 130 fellowship-trained urologic oncologists between 2012 - 2020 submitting their initial case logs within the first year of practice. Cases were subsequently divided using CPT codes into different subspecialty domains: general, reconstructive urology, urogynecology, oncology, men's health, and endourology. Surgeon demographic information was also compared. RESULTS: A total of 24,154 cases were reported, with a median number of 171 (IQR 120-230) cases per recent graduate during the one-year collection period. The most commonly performed cases were oncology (67, IQR 48-94), followed by endourology (33, 17-64), general (34, 21-53), and Men's health (5, 2-17). Most of the graduates were male (n=118, 91%). There were no significant differences in case load between males and females (p>0.05 for all; Figure 1A). However, oncologists in private practice performed more cases overall, including more general, men's health, endourology, and urogynecologic cases (p<0.05 for all). There was no significant difference in oncologic cases between academic (71, IQR 50-98) and private practice (64, IQR 48-86, p=0.31) (Figure 1B). Per graduate, the most common oncologic cases performed were prostate needle biopsy (18, IQR 10-31), followed by TURBT (14, IQR 8-22), radical/partial nephrectomy (11, IQR 5-17), and radical prostatectomy (8, IQR 4-13). The most common general procedure was an insertion of a ureteral stent (20, IQR 20-33). CONCLUSIONS: After fellowship, early career urologic oncologists are likely to have a practice with the majority of cases being general and endourology (11451, 47%), with a variability depending on type of practice. Most importantly, the load of oncologic cases is steady and did not vary by gender or type of practice. This data can be used to guide the expectations of those considering urologic oncology. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e397 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Anthony E. Fadel More articles by this author Elizabeth Bearrick More articles by this author Bridget L. Findlay More articles by this author Ekamjit S. Deol More articles by this author R. Houston Thompson More articles by this author Timothy D. Lyon More articles by this author Douglas A. Husmann More articles by this author Boyd Viers More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction Prostate size exhibits considerable variation among men. Recent evidence from computational, pathologic, and radiologic studies has suggested that enlarged prostates may confer protection against the development of aggressive prostate cancer. In theory, small prostates provide a relatively androgen resistant milieu compared to large prostates, and cancers that develop in smaller glands may be more likely to be androgen resistant and thus aggressive. Nonetheless, the relationship between prostate size and perioperative and oncological outcomes remains uncertain. To address this gap, we studied the association between pathologic prostate specimen weight and perioperative and long-term oncologic outcomes after radical prostatectomy. Methods This study queried the Mayo Clinic's prospectively maintained prostatectomy registry from 1986 to 2017. This study included patients with non-metastatic pathologically confirmed prostate adenocarcinoma and excluded patients that had undergone prior BPH therapy or had previously been taking androgen deprivation therapy. Prostate size was determined using pathologic specimen weight. Prostate sizes were grouped into multiples of 25gm. Multivariable cox analysis evaluated biochemical recurrence after controlling for age, PSA, grade, stage, surgical year, surgical approach, and adjuvant therapy. Using 0-25gm prostates as the reference group, several multivariable logistic regressions were conducted to assess the odds of positive surgical margins, incontinence, and erectile dysfunction at the one-year postoperative mark. Results In a cohort of 19,160 patients undergoing radical prostatectomy, most patients had prostates between 0-50gm (81%), while 13.6%, 3.44%, and 1.80% had prostate sizes of 50-75gm, 75-100gm, and 101+gm, respectively. Patients with larger prostates had higher PSAs and had a lower incidence of positive surgical margins (Table 1). They also had a lower incidence of complete nerve sparing, post-operative potency without medications at 1-year, and post-operative continence at 1-year. On multivariable regression analysis (Figure 1), increasing prostate size was associated with lower risk of positive margins, reduced biochemical recurrence and increased risk of incontinence at 1-year. However, the risk of post-operative impotence at 1-year did not significantly vary by prostate size. Conclusions Larger prostates had a lower risk of positive surgical margins, and despite adjusting for margin status and other pathological variables, they were associated with a lower risk of biochemical recurrence. There was no significant independent association of prostate size with post-operative functional outcomes. This information can be useful for individualizing surgical counseling. It also supports the hypothesis that smaller prostates developing in a relatively androgen deficient milieu may form more aggressive cancers than those that develop in larger prostates. Further research to understand the biologic basis of this observation is warranted.

Background: Sarcopenia, characterized by low muscle mass, and aberrant adiposity changes, including visceral fat accumulation, has been associated with impaired physiologic stress response and wound healing. Artificial urinary sphincter (AUS) placement is the preferred surgical treatment for men with severe post-prostatectomy incontinence. Given the higher rates of maladaptive body composition changes in this older, high comorbidity population, this study explores their impact on AUS outcomes. Methods: A retrospective analysis was performed including men who underwent primary AUS placement at the Mayo Clinic from 1999 to 2023 for post-prostatectomy incontinence and had cross sectional imaging available within 12 months prior to AUS implant. Sarcopenia and body composition were assessed from the available computed tomography (CT) scan using an algorithm that measures the area of different tissues at the L3 abdominal cross-section. The study investigated the association between sarcopenia [defined as skeletal muscle index (SMI) <52.4 cm(2)/m(2)] and adiposity (defined by total visceral and subcutaneous fat area) with all-cause reoperation, including specific etiologies of device infection/erosion, urethral atrophy, and device malfunction, using Cox proportional hazards models. Results: There were 111 patients who had available imaging within the study timeframe, 61 (55%) of whom were classified as sarcopenic. Follow-up did not differ significantly between the two groups [2.11 (0.53-4.78) vs. 2.52 (0.36-5.80) years, P=0.52]. Sarcopenic patients had a lower body mass index (BMI) (29.1 vs. 32.7 kg/m(2); P<0.001). No significant difference in overall device survival was observed between sarcopenic and non-sarcopenic patients (P=0.94) on Cox survival analysis. Sarcopenic patients had higher device infection rates, accounting for 16.7% (3/18) of device failures in the sarcopenic cohort compared to none in the non-sarcopenic cohort. Conclusions: Sarcopenia was prevalent among AUS patients but did not significantly impact overall device survival. These findings suggest that AUS placement may be feasible to perform in well-selected sarcopenic patients.

You have accessJournal of UrologyReconstruction: Ureteral Reconstruction (Including Pyeloplasty) and Bladder Reconstruction (Including Trauma-Related Fistula) I (MP48)1 May 2024MP48-10 URINARY OUTCOMES AND PATIENT SATISFACTION FOLLOWING BLADDER FLAP SURGERY FOR URETERAL STRICTURES Anthony E. Fadel, Elizabeth Bearrick, Bridget L. Findlay, Miriam Dash, Katherine T. Anderson, and Boyd Viers Anthony E. FadelAnthony E. Fadel , Elizabeth BearrickElizabeth Bearrick , Bridget L. FindlayBridget L. Findlay , Miriam DashMiriam Dash , Katherine T. AndersonKatherine T. Anderson , and Boyd ViersBoyd Viers View All Author Informationhttps://doi.org/10.1097/01.JU.0001009512.15743.d7.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstruction of mid- and distal ureteral strictures can be managed by reimplant, with adjunctive maneuvers including psoas hitch and bladder flap available to gain additional length. Patient reported functional outcomes following bladder flap are understudied, and thus, the objective was to report postoperative reconstructive and patient-reported outcomes of ureteral reimplant with bladder flap. METHODS: From a single surgeon ureteral reconstructive database from 2018 – 2022, 81 patients were identified that underwent bladder flap surgery for treatment of ureteral strictures. Data were collected on 52 patients who were surveyed postoperatively to assess urinary outcomes (Urinary Distress Inventory Short Form, UDI-6) and overall surgery satisfaction. The overall survey response rate was 62% (32/52). RESULTS: Bladder flap was performed in 57 ureters in 52 patients at a median age of 59. The majority were female (n=32, 62%) and had robotic surgery (n=29, 56%). In total, 20 (39%) patients had prior radiation and 26 (50%) were combined cases. The median bladder flap length was 6 cm (IQR 4-8) and length did not differ significantly between the irradiated and non-irradiated cohorts (p=0.15) (Table 1 for cohort characteristics). Postoperatively, the median UDI-6 score was 42 (IQR 33-58). Overall scores were not associated with prior radiation (p=0.76) nor robotic approach (p=0.21), however those that were irradiated had worse urine leakage related to surgery (median score of 1 vs 2, p=0.04). Bladder flap length was not associated with worse urinary outcomes (defined as great or moderate disturbance, p>0.05 for all). 16 patients (50%) reported that their symptoms did not interfere with their life, while 6 (19%) reported severe interference. Overall patient satisfaction rate with their flap procedure was 91% (n=29). CONCLUSIONS: Bladder flap is safe and well tolerated, with excellent reconstructive outcomes. Following reconstruction, patients report minimal changes in urinary symptoms, even in select patients with a history of radiation. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e776 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Anthony E. Fadel More articles by this author Elizabeth Bearrick More articles by this author Bridget L. Findlay More articles by this author Miriam Dash More articles by this author Katherine T. Anderson More articles by this author Boyd Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Invasive III (PD34)1 May 2024PD34-06 CHANGES IN BODY COMPOSITION FOLLOWING NEOADJUVANT CHEMOTHERAPY FOR PATIENTS UNDERGOING RADICAL CYSTECTOMY Ekamjit S. Deol, Grant Henning, Spyridon Basourakos, Anthony E. Fadel, Abhinav Khanna, Matthew K. Tollefson, Robert Tarrell, Prabin Thapa, R. Houston Thompson, Robert J. Karnes, Boyd R. Viers, Stephen A. Boorjian, Igor Frank, and Vidit Sharma Ekamjit S. DeolEkamjit S. Deol , Grant HenningGrant Henning , Spyridon BasourakosSpyridon Basourakos , Anthony E. FadelAnthony E. Fadel , Abhinav KhannaAbhinav Khanna , Matthew K. TollefsonMatthew K. Tollefson , Robert TarrellRobert Tarrell , Prabin ThapaPrabin Thapa , R. Houston ThompsonR. Houston Thompson , Robert J. KarnesRobert J. Karnes , Boyd R. ViersBoyd R. Viers , Stephen A. BoorjianStephen A. Boorjian , Igor FrankIgor Frank , and Vidit SharmaVidit Sharma View All Author Informationhttps://doi.org/10.1097/01.JU.0001008768.36634.79.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although neoadjuvant chemotherapy (NAC) is standard of care for patients with bladder cancer undergoing radical cystectomy (RC), there can be substantial associated toxicities. We sought to characterize the impact of NAC on body composition parameters and post-op complication rates. METHODS: Our institutional cystectomy registry was queried for patients undergoing RC between 2000-2020 to identify a subset receiving NAC. This cohort was matched based on age, gender, and clinical stage to those receiving upfront RC. CT images obtained during the pre-op and post-op period were analyzed using a validated deep-learning algorithm for defining skeletal muscle and adipose areas at the L3 level. Our primary objective was to characterize changes in body composition measures over time. We additionally used logistic regression to determine associations between 90-day post-op complications and body composition metrics including sarcopenic obesity and visceral to subcutaneous fat ratio (VF:SQF ratio). RESULTS: 259 patients receiving NAC prior to RC were identified, of whom 187 (72.2%) received GC, 41 (15.8%) MVAC, and 31 (12.0%) any other regimen. 358 patients undergoing upfront RC were identified as a control cohort. Although a median Skeletal Muscle Index (SMI) of 52 cm2 was noted prior to treatment, patients receiving NAC had a significant decline in SMI (Figure 1) and no difference in SMI was seen at the time of RC compared to the control cohort (49.4 cm2 vs. 50.7 cm2, p=0.42). VF:SQF ratio remained stable during NAC (pre-NAC: 0.96 to post-NAC: 0.96, p=0.62), and there was no significant difference in VF:SQF at time of RC between NAC and control cohorts (0.96 vs 0.99, p=0.18). On regression analysis, pre-op sarcopenic obesity (OR: 1.71, p=0.03) and VF:SQF ratio (OR: 1.40, p=0.01) were significantly associated with major complications. There was no significant interaction between the use of neoadjuvant chemotherapy and presence of sarcopenic obesity or VF:SQF ratio. CONCLUSIONS: NAC is associated with significant declines in SMI and progression to sarcopenic obesity prior to RC. Presence of sarcopenic obesity, and high VF:SQF ratio were associated with increased surgical complications. These results highlight the utility of AI-derived body composition measures in individualizing pre-op patient counselling. Download PPT Source of Funding: Thomas P. and Elizabeth S. Grainger Urology Fellowship Fund © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e720 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ekamjit S. Deol More articles by this author Grant Henning More articles by this author Spyridon Basourakos More articles by this author Anthony E. Fadel More articles by this author Abhinav Khanna More articles by this author Matthew K. Tollefson More articles by this author Robert Tarrell More articles by this author Prabin Thapa More articles by this author R. Houston Thompson More articles by this author Robert J. Karnes More articles by this author Boyd R. Viers More articles by this author Stephen A. Boorjian More articles by this author Igor Frank More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (Including Stricture) II (MP32)1 May 2024MP32-01 FUNCTIONAL AND PATIENT REPORTED OUTCOMES IN NON-TRANSECTING EXCISION-ANASTOMOSIS URETHROPLASTY FOR LENGTHY (≥2CM) URETHRAL STRICTURES Alexandr M. Pinkhasov, Anthony E. Fadel, Katherine T. Anderson, and Boyd R. Viers Alexandr M. PinkhasovAlexandr M. Pinkhasov , Anthony E. FadelAnthony E. Fadel , Katherine T. AndersonKatherine T. Anderson , and Boyd R. ViersBoyd R. Viers View All Author Informationhttps://doi.org/10.1097/01.JU.0001008816.80828.35.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For lengthy bulbar strictures (≥2cm), many advocate for oral mucosa substitution urethroplasty due to the concern of penile shortening or other erectile function related side effects. Although effective, substitution bulbar urethroplasty is associated with graft harvest morbidity and may have lower success rates relative to non-substitution non-transecting techniques. We describe outcomes of an extended non-transecting excision-anastomosis urethroplasty for lengthy urethral strictures without the use of graft augmentation. METHODS: A tertiary center's urethroplasty database was queried for patients that underwent non-transecting bulbar urethroplasty from 2017-2023. Stretch penile length (SPL) was assessed pre- and post- operatively and at 3-6 months follow-up. Urethral stricture recurrence was defined as the need for repeat intervention. A survey comprised of urethral stricture surgery patient reported outcome measure (USS-PROM), urinary symptom interference (USI), penile complications (PC), international index of erectile function (IIEF-5) and overall patient satisfaction (OPS) was collected(N=39). Association between groups was assessed with Fischer's exact test and Mann Whitney U test. RESULTS: A final cohort of 90 patients with a median urethral stricture length of 1.5cm (range 0.5-6cm) were identified. When stratified by stricture length ≥2cm (N=41) and <2cm (N=49) median length of urethrotomy was 3cm (2.6-4.0) vs 2 cm (2.0-3.0; p<0.001). At a median follow up of 13 months (IQR 4-18), stricture recurrence was noted in 3(7%) and 2(4%) patients (p=0.89). The overall median change in SPL was 3.5% and 0% (p=0.002). There were no significant differences in relative improvement of Qmax, PVR, 30d complications (15% vs 14%) or urinary extravasation on VCUG (2% vs 4%) (all p>0.05). When assessing for PC, there was no significant difference in patient perceived glans firmness, angulation, ejaculation, sensation, or penile length (all p>0.05). When erectile function was assessed with IIEF-5, there was no significant difference in total score between groups (23 vs 23, p=0.83). USS-PROM (12 vs 8) and USI (1 vs. 2) was not significantly different between groups (p=0.08 and p=0.09, respectively). OPS was higher in patients with shorter repairs (median 4 vs 3, p=.03). CONCLUSIONS: Spongiosal sparing non-transecting urethroplasty is an effective surgical option for patients with lengthy urethral strictures. It offers comparable improvement in functional outcomes including Qmax, PVR, stricture recurrence, as well as subjective patient reported outcomes all while avoiding the morbidity of graft harvesting. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e514 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexandr M. Pinkhasov More articles by this author Anthony E. Fadel More articles by this author Katherine T. Anderson More articles by this author Boyd R. Viers More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:Vesicourethral anastomotic stenosis after radical prostatectomy is a complication with significant adverse quality-of-life implications. Herein, we identify groups at risk for vesicourethral anastomotic stenosis and further characterize the natural history and treatment patterns.MATERIALS AND METHODS:Years 1987-2013 of a prospectively maintained radical prostatectomy registry were queried for patients with the diagnosis of vesicourethral anastomotic stenosis, defined as symptomatic and inability to pass a 17F cystoscope. Patients with follow-up less than 1 year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of vesicourethral anastomotic stenosis. Functional outcomes were characterized.RESULTS:Out of 17,904 men, 851 (4.8%) developed vesicourethral anastomotic stenosis at a median of 3.4 months. Multivariable logistic regression identified associations with vesicourethral anastomotic stenosis including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and nonnerve-sparing techniques. Robotic approach (OR 0.39, P < .01) and complete nerve sparing (OR 0.63, P < .01) were associated with reduced vesicourethral anastomotic stenosis formation. Vesicourethral anastomotic stenosis was independently associated with 1 or more incontinence pads/d at 1 year (OR 1.76, P < .001). Of the patients treated for vesicourethral anastomotic stenosis, 82% underwent endoscopic dilation. The 1- and 5-year vesicourethral anastomotic stenosis retreatment rates were 34% and 42%, respectively.CONCLUSIONS:Patient-related factors, surgical technique, and perioperative morbidity influence the risk of vesicourethral anastomotic stenosis after radical prostatectomy. Ultimately, vesicourethral anastomotic stenosis is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men, with a high rate of retreatment by 5 years.