Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

Abstract

SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 – both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.

Do preoperative leukocyte and neutrophil levels have a predictive value on the complications of hypospadias repair in children?

“…Several medications with anti-inflammatory effect have been used to treat urethral strictures either systematically or locally (6)(7)(8)(9)(10). In adult's series, it was reported that neutrophillymphocyte ratio (NLR) revealed the inflammatory status of the urethral tissue predicting urethral stricture after non-hypospadias surgery (11). Also, NLR was shown as a marker to predict for systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy (12).…”

The contribution of the immune system to genitourinary fibrosis

“…The plasma neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are nonspecific markers of systemic inflammation. [58][59][60] Given that platelet, neutrophil, and lymphocyte counts are often included as routine lab work for patients, there has been significant interest in evaluating these markers in the setting of urethral strictures. 58,60 One study demonstrated higher absolute neutrophil count and NLR in subjects with recurrent urethral stricture after undergoing DVIU, suggesting that chronic inflammation may contribute to stricture recurrence.…”

“…[58][59][60] Given that platelet, neutrophil, and lymphocyte counts are often included as routine lab work for patients, there has been significant interest in evaluating these markers in the setting of urethral strictures. 58,60 One study demonstrated higher absolute neutrophil count and NLR in subjects with recurrent urethral stricture after undergoing DVIU, suggesting that chronic inflammation may contribute to stricture recurrence. 60 PLR, but not NLR, was predictive of stricture development in individuals undergoing transurethral resection of the prostate (TURP), a common procedure for management of benign prostatic hyperplasia that carries a small risk of associated urethral strictures.…”

“…58,60 One study demonstrated higher absolute neutrophil count and NLR in subjects with recurrent urethral stricture after undergoing DVIU, suggesting that chronic inflammation may contribute to stricture recurrence. 60 PLR, but not NLR, was predictive of stricture development in individuals undergoing transurethral resection of the prostate (TURP), a common procedure for management of benign prostatic hyperplasia that carries a small risk of associated urethral strictures. 58 NLR was found not to predict stricture recurrence in patients undergoing urethroplasty.…”

“…NLR and PLR are inconsistent in their ability to predict urethral stricture behavior but given the ease of collection of these markers, further evaluation may be warranted. 58,60 In addition, degree of pelvic trauma is not consistently associated with urethral stricture formation. 47 Further investigation is needed, given the potential for bladder dysfunction and subsequent renal failure as well as the patient morbidity associated with repeated surgeries following failure of initial management.…”