Same-day outpatient anterior urethroplasty feasible

Single-stage anterior urethroplasty is feasible and safe when performed as a same-day outpatient procedure, even for men requiring combined substitution repairs, said University of Pittsburgh Medical Center urologists at the 2016 AUA annual meeting in San Diego.

They presented their findings from a retrospective review of 91 consecutive anterior urethroplasties performed over a 34-month period. Senior author Mang Chen, MD, assistant professor of urology and reconstructive urologist, performed all of the surgeries that comprised 11 anastomotic and 80 substitution procedures. Seventy-five men (82%) were discharged on the day of surgery, and 16 were admitted to the hospital, with an average length of stay of 1.48 days. Seven of the admissions were planned preoperatively for reasons of patient preference or medical comorbidities.

The rate of non-operative complications during the first 30 days postoperatively was low overall and did not differ significantly when comparing the same-day discharge and admitted groups. Success was also similar among the men discharged the same day and those who were admitted (reoperation rate, 16% vs. 18%).

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“According to national data, the average length of stay after uncomplicated anterior urethroplasty is about 2.5 days. Recently, some groups have reported their experience with ‘outpatient’ urethroplasty, but some of those series included patients with hospital stays less than 24 hours and mostly anastomotic repairs,” said first author Jeremy Reese, MD, MPH, who was a urology resident the University of Pittsburgh Medical Center at the time of the study.

“To our knowledge, our report is larger than any published single surgeon series of same-day anterior urethroplasty. We believe its findings support the feasibility of this approach and indicate that rather than any stricture-related characteristics, patient preference and non-urological comorbidities may be the main factors precluding same-day discharge,” added Dr. Reese, a fellow in advanced laparoscopy and robotics at Cleveland Clinic.

Of the 91 urethroplasties included in the analysis, 57% were ventral onlays, 10% were dorsal onlays, 21% were combination dorsal/ventral grafts, and 12% were anastomotic repairs. Ventral onlays represented a significantly higher proportion of cases in the same-day discharge group compared with the admitted group (65% vs. 25%) and there was a nonsignificant trend for more combined cases in the admitted group (37.5% vs. 17%).

“Likely patient and surgeon preference, the more involved nature of the surgery, and a history of having more failed prior endeavors explain the higher admission rate for the combined cases,” Dr. Reese said.

Next: No sig. differences in mean stricture length

No sig. differences in mean stricture length

There were no significant differences between the same-day discharge and admitted groups in mean age, mean stricture length, or proportions of patients with prior instrumentation or urethroplasty procedures. Stricture etiology was unknown for a large proportion of men in each study group, but trauma was the most common identified cause in both.

With men categorized by procedure type, there was a statistically significant difference in reoperation rate only for the combined dorsal/ventral onlay subgroup, and it was higher for men who had same-day surgery than for those who were admitted (46% vs. 33%).

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“Symptoms in patients with a failed combination repair were successfully alleviated in all but one case by direct vision internal urethrotomy,” Dr. Reese said.

Postoperative complications included a single case of new-onset erectile dysfunction and five urinary tract infections that were more common among the admitted men than in the same-day discharge group (13% vs. 4%), possibly reflecting the more prolonged duration of catheterization in the admitted group, said Dr. Reese.