Urethral Reconstruction in Patients With Neurogenic Bladder Dysfunction Jessica T. Casey, Bradley A. Erickson, Neema Navai, Lee C. Zhao, Joshua J. Meeks and Chris M. Gonzalez* From the Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois Purpose: There is limited literature examining urethral reconstruction in patients with neurogenic bladder dysfunction. We describe our experience of urethral reconstruction in men with concurrent neurogenic bladder. Materials and Methods: A prospectively maintained database of all urethral reconstruction procedures performed by 1 surgeon was analyzed for patients with neurogenic bladder dysfunction. Patient characteristics including the etiology of neurogenic bladder, urethral pathology, urethral reconstructive technique, complications and recurrences were evaluated. Results: A total of 23 patients were included in the analysis. Urethral pathology included erosions (10), strictures (7), diverticula (3), urethrocutaneous fistulas (2), and a combination of diverticular and stricture disease (1). Median length of the urethral pathology was 5.0 cm (range 2.0 to 10.0). Overall urethral reconstruction was successful in 16 of 23 patients (69.6%) at a mean followup of 24.7 months (range 2 to 79). Success rates differed among the types of pathology with 60% for urethral erosions, 85.7% for urethral strictures, and 66.6% for urethral diverticula and fistulas. Of those cases of recurrence 4 of 7 (57%) were after urethral erosion repair. There was 1 (4.3%) postoperative complication and no patient underwent urinary diversion after recurrence. Conclusions: When identified at an early stage, urethral reconstruction in patients with neurogenic bladder dysfunction offers acceptable outcomes with limited morbidity. Men undergoing reconstruction for urethral erosion had inferior outcomes compared to those with other urethral pathology. Key Words: urinary bladder, neurogenic; spinal cord injuries; reconstructive surgical procedures; urinary catheterization; urethral stricture P atients with neurogenic bladder dysfunction depend on a variety of bladder management methods includ- ing CIC, indwelling urethral and SPC, urinary diver- sion, and external collecting devices. Prolonged use of these bladder management programs has been associated with significant urological complications including infection (cys- titis, pyelonephritis, epididymitis), 1,2 stone disease (upper tract stones, bladder stones), 3 progressive renal damage, 4,5 urethral erosion, urethrocutaneous fistula and urethral stricture disease, the last of which has been reported in as many as 12% to 23% of patients with neurogenic bladder dysfunction. 2,4,5 Urethral reconstruction offers a treatment choice which may minimize some of the various complications and quality of life issues associated with prolonged suprapubic catheter use or urinary diversion in men with neurogenic bladder dysfunction. 6,7 However, there are conflicting data from smaller series on the outcomes of urethral reconstruction in these men with success ranging from as little as 24% to as high as 66%. 8 –10 We evaluate our 5-year experience with urethral reconstruction in patients with a variety of urethral complications and concomitant neurogenic bladder dysfunc- tion. MATERIALS AND METHODS A prospectively maintained database of all urethral recon- structive procedures by 1 surgeon (CMG) from July 2002 to May 2007 was retrospectively reviewed for patients with neurogenic bladder dysfunction at reconstruction. Patient characteristics were evaluated including the eti- ology of neurogenic bladder, urethral pathology, urethral reconstructive technique, complications and outcomes. A diagnosis of neurogenic bladder was reached by urody- namic criteria in 11 of 23 (47.8%) patients with the re- mainder diagnosed based on clinical parameters. Compli- cations were defined as any deviation from the normal postoperative course within 30 days of surgery. Recur- rence in patients with strictures, diverticula or fistulas was defined as the need for secondary procedures due to the development of urethral pathology in the area of re- construction. In patients requesting urethral erosion re- pair for sexual dysfunction or aesthetic reasons related to body image, recurrence was defined as any breakdown of the reconstructed urethra. Patients were evaluated postoperatively at 1 week, 3 weeks, 2 months, 6 months and then annually. Postoper- ative treatment included an indwelling urethral catheter Submitted for publication December 10, 2007. * Correspondence: Department of Urology, Feinberg School of Medicine, Northwestern University, Tarry 16-749, 303 East Chi- cago Ave., Chicago, Illinois 60611 (telephone: 312-908-8600; FAX: 312-908-7275; e-mail: cgonzalez@nmff.org). 0022-5347/08/1801-0197/0 Vol. 180, 197-200, July 2008 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2008 by AMERICAN UROLOGICAL ASSOCIATION DOI:10.1016/j.juro.2008.03.056 197