Dorsal onlay skin graft urethroplasty in patients older than 65 years

Single-stage dorsal onlay graft urethroplasty is effective for anterior urethral reconstruction. Despite an aging population, the results of this technique in elderly patients have not yet been explicitly reported. We present our experience with dorsal onlay graft urethroplasty in this cohort.

We reviewed all urethroplasties performed on males older than 65 years with at least 6 months follow-up. All exhibited extensive anterior urethral strictures precluding anastomotic urethroplasty. Dorsal onlay skin graft urethroplasty was done after stricturotomy using either penile or groin skin grafts. The neourethra was then tubularized in a single stage. Pre- and postoperative urethrograms, urethral ultrasound, and flow measurements were performed in all.

Forty-two men (mean age 69.25 years) underwent dorsal onlay urethroplasty. Mean graft length was 5.35 cm (range, 3-12). Penile skin was used in 29 and groin skin in 13. Average follow-up was 57.17 months (range, 29-82). Complications occurred in 4 (9.5%), including fistula formation and stricture recurrence. Final success rate was 90.5%. Compared with patients younger than 65 years, there were slightly more failures. Despite prolonged lithotomy position, we did not observe neurovascular lower extremity injuries. Perioperative complications were uncommon.

Dorsal onlay skin graft urethroplasty can be reliably used in older men with extensive urethral strictures. Although recurrence rates seem to be slightly higher, urethroplasty is generally well tolerated in this cohort of patients. Given the favorable outcome of the dorsal onlay technique, urethral reconstruction should not be withheld solely on the basis of age. Regarding the lifelong benefits of repair, the increased complication rates appear negligible.