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Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching

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Abstract

Purpose

Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU).

Methods

From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo.

Results

Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm.

Conclusion

SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.

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Data availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

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Funding

The present study did not receive any funding.

Author information

Authors and Affiliations

  1. Center for Urethral and Genitalia Reconstructive Surgery, Humanitas Cellini, Via Benvenuto Cellini 5, 10126, Turin, Italy

    Enzo Palminteri

  2. Department of Urology, University of Modena and Reggio Emilia, Via Università 4, 41121, Modena, Italy

    Stefano Toso

  3. Urology Clinic-A.O.U. “Città della Salute e della Scienza”-Molinette Hospital, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy

    Mirko Preto

  4. CURE Group, Department of Urology, Hesperia Hospital, Via Arguà 80, 41125, Modena, Italy

    Lorenzo Gatti & Giovanni Ferrari

  5. Department of Urology and Reconstructive Andrology, Humanitas Gradenigo, Corso Regina Margherita 8, 10153, Turin, Italy

    Omid Sedigh

  6. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy

    Omid Sedigh, Nicolò Maria Buffi & Andrea Gobbo

  7. Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Nicolò Maria Buffi & Andrea Gobbo

Authors
  1. Enzo Palminteri
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  2. Stefano Toso
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  3. Mirko Preto
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  4. Lorenzo Gatti
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  6. Nicolò Maria Buffi
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  7. Giovanni Ferrari
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  8. Andrea Gobbo
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Contributions

EP: project development, data analysis, and manuscript writing. ST: data collection and data analysis. MP: data collection and data analysis. LG: project development and data collection. OS: project development and manuscript writing. NMB: project development and manuscript writing. GF: manuscript writing. AG: project development, data analysis, and manuscript writing.

Corresponding author

Correspondence to Andrea Gobbo.

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The Ethics Committee was not inquired about this study because of the retrospective design and all the procedures being performed were part of the routine care. Data were obtained for clinical purposes.

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All patients signed an informed consent for retrospective data collection and publication under anonymity.

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Palminteri, E., Toso, S., Preto, M. et al. Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching. World J Urol 42, 123 (2024). https://doi.org/10.1007/s00345-024-04795-8

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