2008 Annual Meeting Abstracts

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Single Stage Urethral Reconstruction Following UroLume^® Failure
Edward R Houser, II, Lydia T. Labocetta*, Jeffrey D. Brady, Kurt A. McCammon, Steven M. Schlossberg, Gerald H. Jordan
EVMS, Norfolk, VA

Introduction:
Recurrent urethral stricture disease after UroLume^® insertion is a common occurrence. Management options include endoscopic resection, additional stent placement and open reconstruction. We describe our experience with post-UroLume^® single stage urethral reconstruction.

Methods:
A retrospective review was performed on 13 patients with recurrent stricture following placement of UroLume^® endoprosthesis. Of the patients, 10 had anterior strictures and 3 had Urolume^® placed for pelvic fracture urethral distraction defect. Reconstruction had been attempted in 6 patients prior to UroLume^® placement. The average time to UroLume^® failure was 22 months (range 2-144). Mean stricture length was 6.7 cm (range 2-13). The primary stricture location was bulbar (7), membranous (3), panurethral (2) and pendulobulbar (1). Single stage reconstruction was completed in all patients. Reconstructive techniques included excision and primary anastomosis (2), augmented anastomosis buccal mucosal graft (BMG) onlay (4), BMG onlay (2), circular penile skin island on dartos fascial flap (3), combined tissue transfer with scrotal skin island (1), and BMG to a perineal urethrostomy (1).

Results:
Mean age at time of reconstruction was 42 years (range 15-60). Median office follow-up was 31 months (range 6-158). In 11 patients (85%) the urethra is patent without further instrumentation. Two patients are on chronic home dilation. There were no complications related to positioning or donor site morbidity.

Conclusions:
Single stage repair following UroLume^® failure is a reasonable option in patients with a variety of stricture locations and etiologies. Overall clinical success in this series is 85% (11/13). Chronic self-dilation has been a successful salvage measure.

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