MP32-02 PERFORMING a VOIDING CYSTOURETHROGRAPHY DOES NOT IMPACT SURGICAL OUTCOMES AFTER BULBAR URETHRAL RECONSTRUCTION AND MAY NOT BE ROUTINELY NEEDED

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (Including Stricture) II (MP32)1 May 2024MP32-02 PERFORMING a VOIDING CYSTOURETHROGRAPHY DOES NOT IMPACT SURGICAL OUTCOMES AFTER BULBAR URETHRAL RECONSTRUCTION AND MAY NOT BE ROUTINELY NEEDED Carlos I. Calvo and Keith F. Rourke Carlos I. CalvoCarlos I. Calvo and Keith F. RourkeKeith F. Rourke View All Author Informationhttps://doi.org/10.1097/01.JU.0001008816.80828.35.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Contrast imaging is commonly performed after urethroplasty prior to catheter removal. The goal of imaging, either in the form of voiding cystourethrogram or peri-catheter urethrogram, is to detect extravasation which could prompt postponement of catheter removal. However, the need for routine imaging is controverted due to a generally low incidence of extravasation, lack of standardized definition of how much extravasation is clinically significant and unclear impact on clinical outcomes. Our objective is to assess whether omitting post-operative imaging has an impact on the clinical outcomes (complications and recurrence rate) after bulbar urethroplasty. METHODS: We performed a matched, case-control analysis comparing patients undergoing voiding cystourethrogram at the time of catheter removal compared to patients without imaging after bulbar urethroplasty. Patients were matched with respect to age, stricture etiology, length and urethroplasty technique. Follow-up consisted of clinical assessment 3 weeks post-operatively with follow-up cystoscopy at 3-4 months and annually thereafter to monitor for symptom recurrence. Primary outcome measures were 90-day complications (Clavien≥2) and stricture recurrence defined as failure to pass a 16Fr flexible videocystoscope. Case matching, Chi-square analysis and Cox regression were conducted with statistical software SPSS v.26. RESULTS: 100 patients undergoing bulbar urethral reconstruction with subsequent voiding cystourethrogram prior catheter removal were compared to 100 matched case controls who did not undergo imaging. The entire cohort (n=200) had a mean age of 42.9 years, mean stricture length of 3.9 cm, 89.0% failed prior endoscopic treatment and most common etiology was idiopathic (62.0%). Apart from the matched variables, groups did not differ with respect to number of failed endoscopic treatment (p=0.82), prior urethroplasty (p=0.09), comorbidities (p=0.54), smoking (p=0.42) or pre-operative bacteriuria (p=1.00). The incidence of extravasation in the VCUG group was 2.0%. Overall 90-day complication rate (Clavien≥2) was 9.5% and stricture recurrence was 7.5% at a median follow-up of 174 months. On Chi-square analysis, the rate of complications did not differ between patients undergoing VCUG and those without imaging (12.0% vs. 7.0%; p=0.34). On log-rank analysis, stricture recurrence did not differ between groups (9.0% vs. 6.0%; p=0.44). CONCLUSIONS: Routine imaging with VCUG after performing a bulbar urethroplasty, does not impact the rate of post-operative complications or stricture recurrence. Surgeons should consider avoiding this potentially unnecessary examination in routine clinical practice. Source of Funding: Not applicable © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e514 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Carlos I. Calvo More articles by this author Keith F. Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...