Multi-stage Urethroplasty with Augmentation Using a Dorsal Graft Inlay Technique Comparing Graft Use in First or Second Stage

Urethral stricture disease can occur throughout the entire length of the male urethra and has a wide variety of potential etiologies1. The standard treatment for this condition is urethroplasty, an open reconstructive procedure aiming to restore urethral patency1.

Urethroplasty covers a wide variety of surgical techniques and can be performed in a single stage or in multiple stages1. The latter option is generally reserved for patients with a very challenging disease1 (often including very dense fibrosis and poor local tissue conditions) and is most commonly performed for urethral strictures in the penile urethra2.

In case of a multi-stage urethroplasty, the first stage generally involves opening the urethra longitudinally over its diseased segment and suturing the urethral edges to the edges of the skin1. After that, a period of urethral rest of at least 3 months is foreseen after which the second stage procedure is performed by tubularizing the urethral plate around a transurethral catheter and closing the dartos layer and skin over the reconstructed urethra1. When the urethral plate is too narrow or of too poor quality to allow retubularization, the urethral plate is incised on the midline and a graft is sutured into the defect in order to augment the urethra enough to allow for retubularization after all1.

This dorsal inlay procedure can be performed during the first or second stage1. To the best of our knowledge, there are no studies that directly compare the outcomes of both approaches and consequently, there is no clear guidance for surgeons as to whether the graft should be administered during the first or second stage of the procedure. Also, there are absolutely no data available to use in a power analysis for a randomized controlled trial investigating this matter.

Against this background, the principal aim of this pilot study is to directly compare both approaches and analyze the failure rate after one year of follow-up. These data will serve as the basis to design a larger trial in the future with failure rate as the primary end-point. Other study objectives are thoroughly described underneath.

• To genarate initial data in terms of need for additional graft surgery for grafting in first stage. End-point time-frame: time period between first and second stage procedure. [Срок оценки: 1 week after second stage surgery]
• To generate initial data in terms of postoperative complications for grafting in first stage and for grafting in second stage. [Срок оценки: Within 90 days after first stage and within 90 days after second stage.]
• To generate initial data in terms of changes in erectile function for grafting in first stage and for grafting in second stage. [Срок оценки: Preoperative, 3 months after first stage (before second stage), 3 months after second stage and 1 year after second stage.]
• To generate initial data in terms of changes in ejaculatory function for grafting in first stage and for grafting in second stage. [Срок оценки: Preoperative, 3 months after first stage (before second stage), 3 months after second stage and 1 year after second stage.]
• To generate initial data in terms of changes in lower urinary tract symptoms for grafting in first stage and for grafting in second stage. [Срок оценки: Preoperative, 3 months after first stage (before second stage), 3 months after second stage and 1 year after second stage.]
• To generate initial data in terms of changes in urinary continence for grafting in first stage and for grafting in second stage. [Срок оценки: Preoperative, 3 months after first stage (before second stage), 3 months after second stage and 1 year after second stage.]
• To generate initial data in terms of changes in quality of life for grafting in first stage and for grafting in second stage. [Срок оценки: Preoperative, 3 months after first stage (before second stage), 3 months after second stage and 1 year after second stage.]
• To generate initial data in terms of (changes in) patient satisfaction for grafting in first stage and for grafting in second stage. [Срок оценки: 3 months after second stage and 1 year after second stage.]
• To generate initial data in terms of change in maximal urinary flow rate (Qmax) for grafting in first stage and for grafting in second stage. [Срок оценки: Preoperative, 3 months after first stage (before second stage), 3 months after second stage and 1 year after second stage.]
• To assess feasibility of randomization. [Срок оценки: After 12 motnhs of follow-up]