Changes in Uroflowmetry Maximum Flow Rates After Urethral Reconstructive Surgery as a Means to Predict for Stricture Recurrence

Erickson, Beth; Breyer, Benjamin N.; McAninch, Jack W.

doi:10.1016/j.juro.2011.07.010

Cited by 49 publications

(37 citation statements)

References 13 publications

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“…When symptoms do not improve or do not improve as much as patients might have anticipated, dissatisfaction may ensue. Interestingly, on multivariate analysis urine flow rates and changes in flow rates, which are historically important measures to assess urethroplasty success, 7 appeared to be less important than the patient perception of voiding complaints independent of flow. This further emphasizes the importance of using PROMs to elucidate what matters most to our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, success after urethroplasty has focused on objective measures such as urinary flow rates, post-void residual volumes and appearance of the urethra on cystoscopy and/or retrograde urethrogram. 7,8 As surgical techniques have become more refined and urethroplasty procedures have become more widespread, 9,10 the incorporation of PROMs during postoperative visits has been recommended to fully evaluate surgical success. 11,12 Our research group previously noted that successful urethroplasty can improve dysuria and voiding pain.…”

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confidence: 99%

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Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures

et al. 2016

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Purpose Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success. Materials and Methods Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction. Results At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07–11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05–2.77 and OR 2.74, 95% CI 1.12–6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07–11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction. Conclusions Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.

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Section: Discussionmentioning

confidence: 99%

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Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures

et al. 2016

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“…9,10 These measures may not always agree with the patient perception of a successful procedure. 11 In more recent years PROMs have become an increasingly important tool after surgery in all disciplines with a major emphasis on improving patient reported satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Lower Urinary Tract Pain and Anterior Urethral Stricture Disease: Prevalence and Effects of Urethral Reconstruction

et al. 2015

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Purpose Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We prospectively characterized lower urinary tract pain in association with urethral stricture disease and assessed the effects of urethroplasty on this pain. Materials and Methods Men (18 years old or older) with anterior urethral stricture disease were prospectively enrolled in a longitudinal, multi-institutional, urethral reconstruction outcomes study from June 2010 to January 2013 as part of TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Preoperative and postoperative lower urinary tract pain was assessed by the validated CLSS. Voiding and sexual function was assessed using validated patient-reported measures, including I-PSS. Results Preoperatively 118 of 167 men (71%) reported urethral pain and 68 (41%) reported bladder pain. Age was the only predictor of urethral pain with men 40 years or younger reporting more pain than those 60 years old or older (81% vs 58%, p = 0.0104). Lower urinary tract pain was associated with worse quality of life and overall voiding symptoms on CLSS and I-PSS (each p <0.01). Postoperatively lower urinary tract pain completely resolved in 64% of men with urethral pain and in 73.5% with bladder pain. There were no predictive factors for changes in lower urinary tract pain after urethral reconstruction. Conclusions Lower urinary tract pain is common in urethral stricture disease, especially in younger men. It is associated with worse quality of life and voiding function. In most men lower urinary tract pain resolves after urethral reconstruction.

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“…Per Erickson et al, sensitivity increases to 92% with flow rates less than 20 ml/sec and specificity increases to 93% with flow rates less than 10 ml/sec. The positive predictive value is 73% with flow rates less than 10 ml/sec and negative predictive value is 96% with flow rates less than 20 ml/sec (17, 18). Choudhary et al compared US versus RUG to intraoperative confirmation of stricture.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Surveillance After Urethroplasty

Zaid

Hawkins

Wilson

et al. 2015

Urology

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Objectives To determine variability in urethral stricture surveillance. Urethral strictures impact quality of life and exact a large economic burden. Although urethroplasty is the gold standard for durable treatment, strictures recur in 8–18%. There are no universally accepted guidelines for post-urethroplasty surveillance. We performed a literature search to evaluate variability in surveillance protocols, analyzed costs, and reviewed performance of each commonly employed modality. Methods Medline search was performed using the keywords: “urethroplasty,” “urethral stricture,” “stricture recurrence” to ascertain commonly used surveillance strategies for stricture recurrence. We included English language manuscripts from the past 10 years with at least 10 patients, and age greater than 18. Cost data was calculated based on standard 2013 Centers for Medicare and Medicaid Services physician’s fees. Results Surveillance methods included retrograde urethrogram/voiding cystourethrogram (RUG/VCUG), cystourethroscopy, urethral ultrasound, AUA-Symptom Score, and post void residual (PVR) and urine flowmetry (UF) measurement. Most protocols call for a RUG/VCUG at time of catheter removal. Following this, UF/PVR, cystoscopy, urine culture, or a combination of UF and AUA-SS were performed at variable intervals. The first year follow-up cost of anterior urethral surgery ranged from $205 to $1,784. For posterior urethral surgery, follow-up cost for the first year ranged from $404 to $961. Conclusions Practice variability for surveillance of urethral stricture recurrence after urethroplasty leads to significant differences in cost.

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Changes in Uroflowmetry Maximum Flow Rates After Urethral Reconstructive Surgery as a Means to Predict for Stricture Recurrence

Cited by 49 publications

References 13 publications

Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures

Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures

Lower Urinary Tract Pain and Anterior Urethral Stricture Disease: Prevalence and Effects of Urethral Reconstruction

The Cost of Surveillance After Urethroplasty

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