Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis.

Autor:	Sterling J; Department of Urology, Yale School of Medicine, New Haven, Connecticut.; Department of Urology, SUNY Upstate Medical University, Syracuse, New York., Simhan J; Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Flynn BJ; Division of Urology, University of Colorado School of Medicine, Aurora, Colorado., Rusilko P; Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania., França WA; Department of Urology, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil., Ramirez EA; Hospital Angeles Mocel, Mexico City, Mexico., Angulo JC; Department of Medical Clinic, Universidad Europea de Madrid, Madrid, Spain., Martins FE; Department of Urology, University of Lisbon, Hospital of Santa Maria, Lisbon, Portugal., Patel HV; Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey., Higgins M; Division of Urology, University of Colorado School of Medicine, Aurora, Colorado., Swerdloff D; Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Nikolavsky D; Department of Urology, SUNY Upstate Medical University, Syracuse, New York.
Jazyk:	angličtina
Zdroj:	The Journal of urology [J Urol] 2024 Apr; Vol. 211 (4), pp. 596-604. Date of Electronic Publication: 2024 Jan 26.
DOI:	10.1097/JU.0000000000003848
Abstrakt:	Purpose: The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. Materials and Methods: A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. Results: Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. Conclusions: D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.
Databáze:	MEDLINE
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