Failed hypospadias repair as etiological factor in male urethral stricture disease

Transcription

1 Failed hypospadias repair as etiological i l factor in male urethral stricture disease Nicolaas Lumen, M.D., Ph.D. Ghent University Hospital Flanders (Belgium) 1

2 Failed hypospadias repair Meatal stenosis urethral stricture Major causes of failed hypospadias repair Incidence (1-30%): Severity of hypospadias Technique Duration of follow-up Barbagli G. et al, Eur Urol 2006 Wilcox D. et al, World J Urol

3 Etiology of male urethral stricture disease Every process urethral trauma Hypospadias surgery Not well studied papers about stricture treatment Failed hypospadias repair? Fenton A. et al, Urology

4 Failed hypospadias repair and workload urethral surgeon More specific information on stricture etiology : 2007: 268 males treated with urethroplasty Subanalysis: Patient s age Stricture location Impact of failed hypospadias repair on stricture etiology Lumen N. et al, J Urol

5 Patient s characteristics Mean age: 47.7 years (range 1-85y.) 45 y.: 150 (56%) <45 y.: 118 (44%) Stricture location: Penile 22.8% Bulbar 48.1% Panurethral/multifocal 13.4% Posterior 14.9% BIAS! Referral center for hypospadias and urethral surgery (BENELUX) overestimation of complex strictures (incl. failed hypospadias repair)? 5

6 Failed hypospadias repair and overall stricture etiology (n=268) , ,4 % 11,19 11,19 9,7 % 4,85 5 3,36 3,73 2,24 1,12 0,75 1,12 1,49 0 transurethral procedure urethral cathete eterisation hypospadias s-surgery prostat atectomy cyst stoscopy brachy hytherapy idiopathic/u /unknown pelvic fracture perineal trauma penile e fracture lichen sclerosus tumor urethritis aetiology 6

7 Failed hypospadias repair and overall stricture etiology: other reports? Fenton A. et al, Urology 2005: 4/175 patients (2.3%) Barbagli G. et al, J Urol 2010: 223/1510 patients (14.7%) BIAS: referral center for failed hypospadias repair? 7

8 Failed hypospadias repair and etiology in young patients (<45y., n=118) etiology (<45 years) ,39 8,47 38,14 19,49 18, ,69 1,69 2,54 1,69 4,24 8 transur urethral procedure e urethra hral catheterisation hypo pospadias-surgery ry prostatectomy cystoscopy y brachytherapy y idio diopathic/unknown n pelvic fracture perineal trauma a penile fracture lichen sclerosus s tumor urethritis

9 And in the older patients??? ( 45 y., n=150) , years 15 13, ,67 5, ,67 1,33 0,67 1,33 3,33 9 transurethral proce cedure* urethral catheteris risation hypospadias-surg urgery* prostatec ectomy* cysto toscopy brachyth therapy idiopathic/unkn known* pelvic fra racture* perineal trauma penile fracture lichen scler lerosus tumor ure rethritis

10 Failed hypospadias repair and etiology in penile urethra 30 28, ,63 15,87 14,29 11,11 4,76 3,17 1, tran ansurethral procedure e ure rethral catheterisation hypospadias-surgery y prostatectomy cystoscopy y brachytherapy y idiopathic/unknown pelvic fracture perineal trauma a penile fracture lichen sclerosus tumor urethritis

11 Failed hypospadias repair and etiology in penile urethra: other reports Fenton A. et al, Urology 2005: 3/59 patients (5%) Barbagli G. et al, J Urol 2010: 223/437 patients (51%) 11

12 Failed hypospadias repair and other stricture locations bulbar panurethral trans ureth hypo idiop pelvi perin penil liche prost cysto brac ureth ral spad athic/ c eal e n tumo ureth atect scop hythe ral cathe iassurg own re ma re osus unkn fractu trau fractu scler r ritis omy y rapy proc teris bulbar 24,8 10,1 3,88 2,33 0, ,1 0 4,65 0, ,65 panurethral ,56 2,78 5, ,9 2, ,33 2,78 8,33 12

13 Failed hypospadias repair and other stricture locations Mundy A. et al. (Eur Urol 2006): 20% bulbar strictures Lumen N. et al. (J Pediatr Urol 2010, in press): 24% bulbar strictures 4% panurethral strictures Cause? Scrotal or penoscrotal hypospadias Former urethral instrumentations/calibration Post-operative operative urethral catheter Perineostomy Coincident idiopathic bulbar stricture 13

14 Conclusions Important impact on the work-load of the urethral surgeon Important etiological factor in younger patients Most important cause of penile strictures 14

15 Thank You Questions? 15