Introduction Male urethral stricture disease Inflammatory conditions of urethra

1. No. 197 Multivariate analysis of the risk factors predicting the outcome of Dorsal Buccal Mucosa Graft Urethroplasty Prashant Mulawkar1, Utpala Mulawkar2 Department of Urology1 and Plastic Surgery2 TirthankarSuperspeciality Hospital, Gaddam Plots, Akola, Maharashtra, India Posters Proudly Supported by: Introduction Male urethral stricture disease Inflammatory conditions of urethra Iatrogenic (urethral instrumentation) Lichen sclerosis – balanitisxeroticaobliterans (BXO) Dorsal Buccal Mucosa Graft Urethroplasty (DBMU) Successful but challenging procedure Results Study period: 2001-12 N=95 (Inflammatory= 56, BXO = 39), Age: 12 to 70 (Mean: 42.5yr). Recurrence = 22 (23.2%). Time to recurrence = 2 Mo – 6 yr Kaplan Meir curve and log rank test Aim To study the risk factors that promote failure of dorsal buccal mucosa graft urethroplasty Methods Retrospective review : Jan 2001 - Oct 2012 Risk factors analysed: Host factors: Age, Smoking, Tobacco chewing, Past pulmonary Kochs, Diabetes, Hypertension, Ischaemic heart disease, Chronic kidney disease, Creatinine at presentation Stricture Factors: Aetiology of stricture: inflammatory/ BXO, Duration of symptoms, Urethral stricture length, Location of the stricture Treatment factors: Prior urethral dilatation, Prior visual internal urethrotomy (VIU), Number of VIUs, Prior open surgery for stricture , Grade of mouth opening, Number of grafts needed, Quality of the grafts, Wound infection, Epididymo-orchitis (post-op), Urethro- cutaneous fistula Followed periodically Obstructive symptom Uroflometry / Urethral calibration / Retrograde urethrogram / Urethrocystoscopy Data Analysis Multiple Logistic Regression Backward selection method with a likely hood ratio for variable entry and removal. Stricture free survival was plotted using Kaplan Meir log rank test curve Association between each risk factor with outcome: Fisher exact test All tests at 5 % level of significance The log rank test indicates no significant (p>0.5587) difference between the BXO and inflammatory group. Predictors of failure of Buccal Mucosa Graft Urethroplasty After multivariate analysis (Multiple logistyic regression. Backward selection method with likelyhood ratio) Tobacco chewing (p=0.007) Hypertension (p=0.0470) Prior VIU (p=0.0101) On univariate analysis (Fisher exact test at5% level of significance) Prior dilatation Number of VIU procedures Quality of graft Epididymo-orchitis Pre-op RGU Post-op RGU Illustrative case • Conclusions • Tobacco chewing, hypertension and prior VIU are predictive of failure after DBMU. • Number of VIU procedures, quality of grafts and epididymo-orchitis may also predict failure after DBMU. References Breyer BN, McAninch JW, Whitson JM et al: Multivariate analysis of risk factors for long term urethroplasty outcome. J Urol 2010; 183:613-617 Acknowledgements Anaesthesiologists: Dr G S Panpaliya, Dr. VinitHingankar, Dr. Deepak Bhat, Dr. NayanaTelkar Statistician: Mr SharadNimbale