Follow up regimen post urethroplasty !

• 30 Mar 2020 07:48:25 PM
• |Reconstructive Urology

Can someone help me with the apt follow up regimen following reconstructive urethroplasty for stricture urethra? What defines Failure?

Comments(5)

• 

  Jaideep Mahajani

  30 Mar 2020 10:22:46 PM

  God has given three times larger diameter of urethra than required.

  Uroflometry will not show reduced flow rate unless and until the diameter of urethra is 8F or less.

  That is why results of urethroplasty are acceptable. Unless post surgery restinosis is severe, patient will not complain. 

  Still I believe, best investigation for followup is uroflometry as it is noninvasive. It is better not to do any invasive study for one year, unless patient complains of narrow stream or uroflo is suggestive of reduced flow rate. 

  Majority of times if there is recurrence, it is within 3 to 6 months. If patient is asymptomatic after one year, then he is less likely to develop recurrence. But ideally followup of urethroplasty should be for decades. If unfortunately you miss recurrence,  in long-term patient can develop renal impairment. 

  I have done redo urethroplasty of a patient in 2008 who's urethroplasty was done in 1982. So there could be recurrence at any time. 

• 

  PANKAJ JOSHI

  31 Mar 2020 07:43:40 PM

  Follow up:

  Urolfow on catheter removal.

  Uroflow every 3 months 

  USG /PVR/sos 

  best is use of PROMS 

  
  

  Uroflow every 3 month for 2 years and then every 6 month for 5 years or whatever possible.

  
  

  Failure:

  Symptomatic poor flow, need for dilatation,VIU 

• 

  Dr. Roy Chally

  31 Mar 2020 09:46:10 PM

  To define success clinically, symptoms and uroflowmetry is adequate. For research and publication urethrogram and cystoscopy is needed during follow up. As mentioned earlier surgical failures are usually seen within a year. Life long follow up is needed to define success. 

• 

  Dr Prashant Mulawkar

  29 Oct 2020 07:21:09 PM

  I fully agree what jaideep and Pankaj as mentioned above. 

  The success of the urethroplasty can be different from different perspectives

  Most commonly used is absence of symptoms or absence of secondary procedures. This is the most practical and most popular definition.

  Invasive Objective measues are cystoscopy, caliberation, RGU

  Non invasive objective measure: uroflometry, PVR on USG

  PROM : Patient reported outcome measures
  

  Sucess, failure can be anatomic or functional

  
  

  So it depends on what you are looking at. 

  I would recommend you to read following article

  
  

  Ref:

  Erickson BA, Ghareeb GM. Definition of successful treatment and optimal follow-up after urethral reconstruction for urethral stricture disease. Urologic Clinics. 2017 Feb 1;44(1):1-9.
  

• 

  Venugopal P

  09 Nov 2020 09:57:31 AM

  Dear All,

  The issue raised by Raju Ranjan on ‘Followup regime post Urethroplasty’ has tickled the feathers and we have suitable replies from some leading luminaries.

  Jaideep Mahajani has informed us as to God’s wisdom in providing the urethra with 3 times the luminal size than it actually requires. This is true as in earlier years; it was considered that Urethral Luminal Size was mentioned as Anatomical Size and Physiological Size. The latter was considered as 1/3^rd of the former. It was also then considered that for symptoms due to Stricture to develop, the luminal size of urethra should become 1/3^rd of the physiological size. Though I used to teach these in my previous years, the pundits of today do not give much relevance for this. On many occasions, though a stricture may be present, it remains asymptomatic and could be so over a long period of time. This is well accepted. This is true as mentioned by Jaideep that even in Post Op Scenario, many patients will remain asymptomatic even after the stricture has recurred.

  The old adage ‘once a stricture, always a stricture’ is apt even today. Most interventions are at best to give temporary solace for the patient. Though we report success after Urethroplasty, many of these patients are advised self calibration/self dilatation as part of continuing treatment. Pankaj and Sanjay, I am sure will frown at this, I am sure. Any instrumentation that is proposed after Urethroplasty, even the need for Urethroscopy after a procedure should be considered as instrumentation. If after treatment, any form of followup treatment has to be advised, then it is logical to presume that the procedure has not yielded the result it was aimed for – Long life lasting Cure from Stricture. Roy has aptly mentioned that ‘lifelong followup is needed to define success’.

  The article provided by Prashant Mulawkar is worth a read and understanding. He has mentioned that ‘Success and failure could be Anatomical or Functional’. I am providing you the Algorithm mentioned in that article.

  I am sure that this might rise a ‘hornet’s nest’ and there could be many more discussions on this topic’

  With warm Regards,

  Venu  

   

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