Elsevier

Urology

Volume 102, April 2017, Pages 229-233
Urology

Reconstructive Urology
Safety and Surgical Outcomes of Same-day Anterior Urethroplasty

https://doi.org/10.1016/j.urology.2016.12.003Get rights and content

Objective

To evaluate the safety and feasibility of same-day anterior urethroplasty at our institution and define predictors of postoperative admission and surgical failure.

Methods

We retrospectively reviewed the charts of 118 consecutive anterior urethroplasties performed at a tertiary care center. Data were analyzed to detect predictors of postoperative admission and urethroplasty failure. The 30-day complications and long-term outcomes were compared between same-day and admitted patients.

Results

Ninety-two patients (78%) were discharged on the day of surgery. A penile stricture location compared with a bulbar stricture location (odds ratio: 13.4, P = .009) and having undergone more than 3 prior endoscopic stricture interventions (odds ratio: 10.2, P = .001) were significantly associated with postoperative admission. Patients with a ventral onlay approach were more likely to be discharged home (P = .03), whereas patients with combined repairs were more likely to be admitted (P = .04). Same-day urethroplasty did not increase 30-day postoperative complications, patient emergency room visits, unplanned clinic visits, or phone calls. Success rates did not differ between same-day (89%) and admitted (79%) cohorts, and no individual stricture characteristic was predictive of urethroplasty failure.

Conclusion

Same-day anterior urethroplasty is safe and feasible and could help increase utilization of urethroplasty for urethral stricture disease.

Section snippets

Methods

After institutional review board approval, we performed a retrospective chart review of 118 consecutive anterior urethroplasties (14 anastomotic, 104 substitution) performed by 2 reconstructive urologists from August 2012 through March 2016. Patients included in the analysis were males >18 years of age who presented for treatment of a urethral stricture. Patients with posterior urethral distraction defects were excluded. We also excluded patients undergoing a first-stage Johanson urethroplasty

Results

Ninety-two of 118 (78%) patients were discharged home the day of surgery. Patients in the same-day and admitted groups did not differ with respect to age, stricture length, stricture location, or stricture etiology (Table 1). However, patients in the admitted group were more likely to have undergone >3 prior endoscopic interventions for their urethral strictures than patients in the same-day group (85% of patients in the admitted group vs 55% of patients in the same-day group, P = .007).

A wide

Discussion

We describe our experience with a same-day approach to anterior urethroplasty. Similar to previous studies, we found no difference in the overall urethroplasty success rates between patients who were admitted postoperatively and those who were discharged on the same day over a mean follow-up of 18.6 months. Lewis et al published the first series of 54 patients managed with outpatient urethroplasty and reported similar success rates between outpatient and admitted groups: 93% versus 88%,

Conclusion

Herein we describe the largest series of same-day anterior urethroplasty to date and include several patients with complex, single-stage, and pan-urethral substitution repairs. Strictures of the penile urethra, shorter strictures, and an increased number of prior endoscopic interventions were significantly associated with postoperative admission. Same-day discharge did not compromise urethroplasty success rates or result in increased postoperative complications. Thorough preoperative counseling

References (8)

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    Our results suggest that postoperative admission may not be necessary in patients undergoing urethroplasty. This observation has been supported by other reports, including a recent study by MacDonald et al that used an overlapping dataset from the NSQIP database.5,6 Studies have reported on the satisfaction and safety of outpatient urethroplasty as well.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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