Periurethral Abscess Following Urethral Reconstruction: Clinical Features and Prognosis

• Published in: Urology (Ridgewood, N.J.) Vol. 161; pp. 111 - 117
• Main Authors: Cook, Grayden S., Kavoussi, Mehraban, Badkhshan, Shervin, Carpinito, Gianpaolo P., Dropkin, Benjamin M., Bhanvadia, Raj R., Joice, Gregory A., Nealon, Samantha W., Sanders, Sarah C., Hudak, Steven J., Morey, Allen F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2022
• Subjects: Abscess - diagnosis; Abscess - etiology; Abscess - therapy; Anti-Bacterial Agents - therapeutic use; Constriction, Pathologic - surgery; Female; Humans; Male; Prognosis; Retrospective Studies; Treatment Outcome; Urethra - surgery; Urethral Stricture - diagnosis; Urethral Stricture - etiology; Urethral Stricture - surgery; Urologic Surgical Procedures, Male - adverse effects; Urologic Surgical Procedures, Male - methods
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2021.12.020

To evaluate the clinical and prognostic details of periurethral abscess (PUA) formation following urethroplasty (UP).
A retrospective review was performed to identify men who developed PUA after UP between 2007 and 2019 at a single tertiary care referral center. Patient demographics, stricture characteristics, and UP technique were recorded. Outcomes included time to PUA, presenting symptoms, wound cultures, imaging, and ultimate management. Comparative analysis between PUA and non-PUA patients was performed using Fisher's Exact test and Student's t-test.
Among 1499 UP cases, 9 (0.6%) developed PUA. Mean stricture length was 4.6 cm with most located in the bulbar urethra (5/9, 56%), while 4/9 (44%) had undergone prior UP. PUA rates were 7/288 (2.4%) and 2/815 (0.3%) for substitution and anastomotic UP respectively. Voiding cystourethrogram (VCUG) demonstrated extravasation in 67% (4/6) of available UP cases imaged. Subsequent VCUG confirmed leak improvement or resolution in all cases. Wound cultures were frequently polymicrobial (4/6, 67%). Management included antibiotics with (6/9) and without (3/9) incision and drainage (I/D). Urinary drainage was performed in 5 patients using suprapubic tube (3/5) and foley placement (2/5). PUA resolution was observed in all patients while stricture symptom recurrence was observed in 2/9 (22%) patients with mean time to recurrence of 15 months. Overall mean follow-up time was 22 months.
PUA is a rare complication of UP that may be more common in setting of postoperative urine leak. PUA is safely managed with I/D, urethral rest, and antibiotics, with low risk of recurrent stricture formation thereafter.