Larger patients shouldn’t have fewer options: urethroplasty is safe in the obese

Abstract

Objective: To examine the impact of obesity on perioperative outcomes and urethral stricture recurrence after anterior urethroplasty. Material and Methods: We reviewed our prospectively maintained single-surgeon database to identify men with anterior urethral strictures who had undergone anastomotic or augmentation urethroplasty between October 2012 and March 2018. In all, 210 patients were included for primary analysis of perioperative outcomes, while 193 patients with at least 12 months follow-up were included for secondary analysis of stricture recurrence. Patients grouped by BMI were compared using univariate and multivariate analyses for perioperative outcomes and log rank testing for recurrence-free survival. Results: Overall, 41% (n=86) of patients were obese and 58.6% (n=123) had bulbar urethral strictures. Obese patients had significantly longer urethral strictures (mean=6.7cm±4.7) than nonobese patients (p <0.001). Though urethroplasty in obese patients was associated with increased estimated blood loss (EBL) relative to normal BMI patients on both univariate (p=0.003) and multivariate (p <0.001) analyses, there was no difference in operative time, length of stay, or complication rate between BMI groups. At a mean follow-up interval of 36.7 months, 15% (n=29) of patients had stricture recurrence, yet recurrence-free survival was not significantly different between groups (log rank p=0.299). Dorsal augmentation urethroplasty resulted in significantly fewer recurrences in obese patients compared to nonobese patients (p=0.036). Conclusion: Despite the association with increased urethral stricture length and EBL, obesity is not predictive of adverse perioperative outcomes or stricture recurrence. Obese patients should be offered urethral reconstruction, but patient selection and preoperative counseling remain imperative.

Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis

“…It is important to note that once the stricture recurred, the success rate of the second operation was significantly reduced. In order to find out the possible causes of postoperative stricture recurrence, and some prognostic factors such as BMI, length of stricture, previous urethroplasty history, direct visual internal urethrotomy (DVIU) history have been reported ( 4 ). However, in addition to these risk factors that have a strong role in promoting stricture recurrence, there are still some risk factors that are relatively mild or need a long time for stricture promotion, which can only be described by a large sample size of clinical research.…”