Reconstructive UrologySafety and Surgical Outcomes of Same-day Anterior Urethroplasty
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
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Cited by (11)
Recent Trends and Advances in Anterior Urethroplasty
2022, Urologic Clinics of North AmericaCitation Excerpt :These patients did not have an increase in 30-day postoperative complications, emergency room visits, unplanned clinic visits, or phone calls. They also had a similar success rate compared with admitted patients.60 Another study also concluded that with appropriate preoperative education and perioperative analgesia, same-day discharge was possible with comparable complication rates and high patient satisfaction.60
Same Day Discharge Versus Overnight Observation Protocols – Similar Outcomes Following Artificial Urinary Sphincter Surgery
2021, UrologyCitation Excerpt :The only published study to report on men actually discharged on the day of AUS insertion found a 6% readmission rate within 3 days of outpatient surgery among 81 French men. SDS safety has additionally been demonstrated in the settings of penile prosthesis insertion (where SDS rates have already risen substantially), anterior urethroplasty, and donor nephrectomy.9-12 Taken together, the findings of these papers suggest that men undergoing AUS surgery who recover appropriately in the PACU can be safely discharged and that the potential need for overnight pain control or catheter management do not routinely justify hospital admission.
EDITORIAL COMMENT
2021, UrologyShort-term Complication Rates Following Anterior Urethroplasty: An Analysis of National Surgical Quality Improvement Program Data
2018, UrologyCitation Excerpt :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.
Financial Disclosure: The authors declare that they have no relevant financial interests.