Objectives
Single-stage dorsal onlay graft urethroplasty is effective for anterior urethral reconstruction.
Despite an aging population, the results of this technique in elderly patients have
not yet been explicitly reported. We present our experience with dorsal onlay graft
urethroplasty in this cohort.
Methods
We reviewed all urethroplasties performed on males older than 65 years with at least
6 months follow-up. All exhibited extensive anterior urethral strictures precluding
anastomotic urethroplasty. Dorsal onlay skin graft urethroplasty was done after stricturotomy
using either penile or groin skin grafts. The neourethra was then tubularized in a
single stage. Pre- and postoperative urethrograms, urethral ultrasound, and flow measurements
were performed in all.
Results
Forty-two men (mean age 69.25 years) underwent dorsal onlay urethroplasty. Mean graft
length was 5.35 cm (range, 3-12). Penile skin was used in 29 and groin skin in 13.
Average follow-up was 57.17 months (range, 29-82). Complications occurred in 4 (9.5%),
including fistula formation and stricture recurrence. Final success rate was 90.5%.
Compared with patients younger than 65 years, there were slightly more failures. Despite
prolonged lithotomy position, we did not observe neurovascular lower extremity injuries.
Perioperative complications were uncommon.
Conclusions
Dorsal onlay skin graft urethroplasty can be reliably used in older men with extensive
urethral strictures. Although recurrence rates seem to be slightly higher, urethroplasty
is generally well tolerated in this cohort of patients. Given the favorable outcome
of the dorsal onlay technique, urethral reconstruction should not be withheld solely
on the basis of age. Regarding the lifelong benefits of repair, the increased complication
rates appear negligible.
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References
- Etiology of urethral stricture disease in the 21st century.J Urol. 2009; 182: 983-987
- Urethral reconstruction.Curr Opin Urol. 2006; 16: 391-395
- Long-term results of internal urethrotomy.J Urol. 1996; 156: 1611-1614
- Ageing populations: the challenges ahead.Lancet. 2009; 374: 1196-1208
- Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications.J Urol. 2004; 172: 201-203
- What is the best technique for urethroplasty?.Eur Urol. 2008; 54: 1031-1041
- Anterior urethral strictures.BJU Int. 2003; 92: 497-505
- The oral mucosa graft: a systematic review.J Urol. 2007; 178: 387-394
- Prevalence of oral mucosal lesions in a representative population.Quintessence Int. 2007; 38: 23-96
- Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption.BMC Urol. 2009; 9: 15
- Postauricular skin as an alternative to oral mucosa for anterior onlay graft urethroplasty: a preliminary experience in patients with oral mucosa changes.Urology. 2009; 74: 345-348
- Oral submucosal fibrosis: a preventable disease.Gut. 1992; 33: 4-6
- Long-term outcomes of penile skin graft versus buccal mucosal graft for substitution urethroplasty of the anterior urethra.J Urol. 2005; 173 (Abstract no. 317): 87
- Interim outcome of the single stage dorsal inlay skin graft for complex hypospadias reoperations.J Urol. 2006; 175: 872-877
- Single-stage dorsal inlay split-skin graft for salvage anterior urethral reconstruction.BJU Int. 2008; 101: 1565-1570
- Dorsal onlay skin graft bulbar urethroplasty: long-term follow-up.Eur Urol. 2008; 53: 628-633
- Dorsal free graft urethroplasty.J Urol. 1996; 155: 123-126
- Surgical treatments for men with benign prostatic enlargement: cost effectiveness study.BMJ. 2009; 338: b1288https://doi.org/10.1136/bmj.b1288
- One-sided anterior urethroplasty: a new dorsal onlay graft technique.BJU Int. 2009; 104: 1150-1155
- Retrospective outcome analysis of one-stage penile urethroplasty using a flap or graft in a homogeneous series of patients.BJU Int. 2008; 102: 853-860
- Hypospadias repair in elderly patients.Geriatrics. 1992; 47: 77-79
- Advanced age does not contribute to increased risks or poor outcome after major abdominal operations.Am Surg. 2001; 67: 1123-1127
- Neurapraxic complications in operations performed in the lithotomy position.World J Urol. 2002; 20: 68-71
- Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease.J Urol. 2008; 179: 2259-2264
- Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique?.J Urol. 2005; 174: 955-958
- The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain.J Urol. 2004; 172 (580-535)
- Comparison of donor site intraoral morbidity after mucosal graft harvesting for urethral reconstruction.Urology. 2005; 66: 716-720
Article info
Publication history
Published online: April 08, 2010
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
