Predicting recurrence after buccal mucosa graft urethroplasty and the best rescue option

What is it about?

This study evaluated factors predicting recurrence after treatment and the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. Of 575 patients treated with ventral onlay BMG urethroplasty, 103 had at least one re-intervention. On multivariable Cox regression analysis, only stricture length ≥5 cm was a predictor of failure. The success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5%, and 25%, respectively. In contrast, for patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3%, and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU, and third rescue DVIU, respectively. These findings suggest that DVIU as a rescue treatment becomes less effective as the number of DVIU treatments performed increases. Open urethroplasty, on the other hand, improves patient outcomes in almost three out of four patients, even in cases of previous failed DVIU treatments for stricture recurrence.

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Why is it important?

This research is important because it evaluates the factors predicting recurrence after treatment and assesses the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. This information is crucial for urologists to make informed decisions about the treatment of patients with urethral stricture disease, as it provides evidence-based guidance on the selection of appropriate endoscopic or surgical procedures based on anatomical location, length of stricture, and prior interventions. Key Takeaways: 1. Approximately one out of five patients treated with ventral BMG urethroplasty will experience treatment failure. 2. Stricture length ≥5 cm is a strong predictor of treatment failure after ventral BMG urethroplasty. 3. DVIU is a good rescue option, but its effectiveness decreases significantly as the number of procedures performed increases. 4. Open redo urethroplasty is associated with a better success rate, even in patients treated with multiple previous endoscopic treatments.