Kantonsspital St.Gallen
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A critical outcome analysis of Asopa single-stage dorsal inlay substitution urethroplasty for penile urethral stricture

Valentin Zumstein, Roland Dahlem, Luis A Kluth, Clemens M Rosenbaum, Valentin Maurer, Omar Bahassan, Oliver Engel, Margit Fisch & Malte W Vetterlein

abstract

PURPOSE
To critically report outcomes from a contemporary series of patients undergoing single-stage Asopa dorsal inlay urethroplasty for penile stricture.

METHODS
First, we retrospectively evaluated patients who underwent Asopa urethroplasty for penile stricture between 2009 and 2016 at our department. Clinical and surgical characteristics were compared across treatment groups (proximal penile, mid-penile, distal penile). Recurrence-free survival was plotted using Kaplan-Meier curves. Treatment satisfaction was assessed using a validated outcome measurement tool. Second, a literature review was performed through Medline to summarize the available evidence on Asopa urethroplasty and put our own results into context.

RESULTS
Of 125 patients, 38 (30%), 74 (59%), and 13 (10%) had distal penile, mid-penile, and proximal penile stricture, respectively. Patients with distal strictures were younger and graft length was shorter compared to other groups (P ≤ 0.009). The majority of strictures were iatrogenic (38%), followed by hypospadias related (24%), congenital (17%), traumatic (10%), inflammatory (9%), and post-infectious strictures (2.4%). At a median follow-up of 36 months, overall success rate was 70%. In sensitivity analyses, success rates were only marginally improved to 71% after exclusion of hypospadias- and lichen sclerosus-associated strictures. Patients with mid-penile strictures were significantly more satisfied compared to other groups. Overall, 272 patients from 9 studies in the literature review underwent Asopa urethroplasty and success rates ranged from 73 to 100%.

CONCLUSIONS
Success rates of Asopa urethroplasty in penile strictures are lower than previously reported. This is most likely due to both complex stricture etiology and surgical history and last resort single-stage surgery in many cases. Pre-operative counseling must consider high recurrence risk and staged urethroplasty should be discussed in selective cases to optimize patient satisfaction.
   
citation Zumstein V, Dahlem R, Kluth L A, Rosenbaum C M, Maurer V, Bahassan O, Engel O, Fisch M, Vetterlein M W. A critical outcome analysis of Asopa single-stage dorsal inlay substitution urethroplasty for penile urethral stricture. World J Urol 2019;.
   
type journal paper/review (English)
date of publishing 18-07-2019
journal title World J Urol
ISSN electronic 1433-8726
PubMed 31321508
DOI 10.1007/s00345-019-02871-y