Urethroplasty Practice Patterns of Genitourinary Reconstructive Surgeons

Introduction: To our knowledge there are no studies evaluating urethroplasty practice patterns among genitourinary reconstructive surgeons. Methods: An electronic survey was sent to members of the Society of Genitourinary Reconstructive Surgeons. Respondents were queried regarding approach to bulbar urethral reconstruction in 6 index cases. Results: A total of 91 society members who regularly treated men with urethral strictures responded to the survey. For a 1.5 cm stricture excision and primary anastomosis was the preferred treatment, although less unanimously than expected (only 83% in older men and 67% in younger men). For 2.5 cm strictures urethroplasty with buccal mucosal graft was the preferred treatment for a 35-year-old man, and excision and primary anastomosis for a 65-year-old man. Excision and primary anastomosis was preferred less frequently in younger patients and in patients with longer strictures (Cochran Q test, p <0.001). No other variables were independently associated with use of excision and primary anastomosis, but there were trends toward increased use of excision and primary anastomosis in higher volume surgeons and surgeons who trained fellows. Of the respondents 90% harvest their own buccal grafts, with 46% leaving harvest sites open and 36% closing them. Of the respondents 48% use stricture location to determine graft placement, while 33% use dorsal onlay and 19% use ventral onlay when substitution urethroplasty is chosen. Conclusions: Urethroplasty consisting of excision and primary anastomosis is performed less commonly than expected among genitourinary reconstructive surgeons. Considerable variation exists regarding operative technique, management of buccal mucosal graft harvest site and substitution onlay site.