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Redo-urethroplasty for the management of recurrent urethral strictures in males: a systematic review

Research output: Contribution to journalReview articlepeer-review

Sara Jasionowska, Oliver Brunckhorst, Rowland W Rees, Asif Muneer, Kamran Ahmed

Original languageEnglish
Pages (from-to)1801-1815
Number of pages15
JournalWorld Journal of Urology
Volume37
Issue number9
Early online date15 Mar 2019
DOIs
Accepted/In press26 Feb 2019
E-pub ahead of print15 Mar 2019
Published1 Sep 2019

Documents

  • Redo-Uretrhoplasty World J Urol

    Redo_Uretrhoplasty_World_J_Urol.pdf, 848 KB, application/pdf

    Uploaded date:20 Aug 2020

    Version:Final published version

    Licence:CC BY

King's Authors

Abstract

PURPOSE: Redo-urethroplasty is a challenge for any genitourethral surgeon, with a number of techniques previously described. This systematic review aims to identify the surgical techniques described in the literature and evaluate the evidence for their effectiveness in managing recurrent urethral strictures.

MATERIALS AND METHODS: A systematic review of the MEDLINE and EMBASE databases from 1945 to July 2018 was performed and the urethroplasty procedures were classified according to the site and surgical technique. Primary outcomes included success rates measured via re-stricture rates and the post-op maximum urinary flow rate. Secondary outcomes included complication rates and patient-reported quality of life.

RESULTS: A total of 39 identified studies met the inclusion criteria. Twenty-two studies described the use of excision and primary anastomotic urethroplasty with success rates showing wide variability (58-100%). Success rates reported according to the site of the stricture also varied: bulbar (58-100%) and posterior (69-100%) recurrent strictures. One-stage substitution urethroplasty was described in 25 studies with success rates of 18-100%, with the best outcomes reported for bulbar (58-100%) and hypospadias-related (78.6-82%) strictures. Two-stage substitution urethroplasty was described in 12 studies with the success rates of 20-100%, with the best evidence related to hypospadias-related and posterior urethral strictures. The buccal mucosa graft was the graft source with the best evidence for substitution urethroplasty (18-100%).

CONCLUSIONS: Trends of effectiveness were identified for redo-urethroplasty modalities in different locations. However, the current levels of evidence are limited to small observational studies, highlighting the need for further larger prospective data to evaluate different techniques used for recurrent urethral strictures.

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