1. The Role of Postoperative Imaging after Ventral Onlay Buccal Mucosal Graft Bulbar Urethroplasty.
- Author
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Hoy NY, Wood HM, and Angermeier KW
- Subjects
- Adult, Cystoscopy statistics & numerical data, Extravasation of Diagnostic and Therapeutic Materials diagnosis, Extravasation of Diagnostic and Therapeutic Materials etiology, Humans, Incidence, Male, Middle Aged, Mouth Mucosa transplantation, Postoperative Care methods, Postoperative Care statistics & numerical data, Postoperative Complications diagnosis, Postoperative Complications etiology, Retrospective Studies, Treatment Outcome, Urethra diagnostic imaging, Urethra surgery, Urethral Stricture pathology, Urinary Catheterization instrumentation, Urologic Surgical Procedures, Male instrumentation, Cystoscopy adverse effects, Extravasation of Diagnostic and Therapeutic Materials epidemiology, Postoperative Care adverse effects, Postoperative Complications epidemiology, Urethral Stricture surgery, Urologic Surgical Procedures, Male adverse effects
- Abstract
Purpose: Our primary objective was to determine the incidence of extravasation on imaging at the time of catheter removal after ventral onlay buccal mucosal graft urethroplasty., Materials and Methods: This is a single center retrospective cohort study of patients who underwent ventral onlay buccal mucosal graft bulbar urethroplasty from 2007 to 2017. Patients with imaging at the time of catheter removal were included. Urethroplasty success was defined as the ability to pass a 17Fr cystoscope at the time of followup cystoscopy., Results: A total of 229 patients met the inclusion criteria, including 110 with a ventral onlay buccal mucosal graft and 119 with an augmented anastomotic urethroplasty with a mean stricture length of 4.4 cm. Imaging consisted of a voiding cystourethrogram in 210 and retrograde urethrogram in 19 patients at a median of 21.7 days after surgery. The incidence of extravasation was 3.1% (7/229). Of patients who had a documented followup cystoscopy (60%, 137/229), those with extravasation on imaging had a worse urethroplasty success rate (60%, 3/5) compared to those who did not (94%, 117/130) (p=0.047). On multivariate analysis those who had 5 or more endoscopic interventions were 9.6 times more likely to demonstrate extravasation (OR 9.6, p=0.0080)., Conclusions: The incidence of radiological extravasation after ventral onlay using a single buccal mucosal graft, with or without augmented anastomotic urethroplasty, is 3.1%. Given this low rate it is reasonable to omit routine imaging at the time of Foley removal in this population. It appears that extravasation may be associated with a worse cystoscopic patency rate but does not lead to more complications.
- Published
- 2020
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