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

Abstract

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.

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

“…While we often assume that pain associated with urethral stricture disease is related to high pressure voiding and, thus, it will improve after successful urethroplasty, previously no correlation was found between postoperative uroflowmetry rates and pain. 3 In our study pain was an independent predictor of dissatisfaction despite controlling for age and stricture recurrence. The postoperative pain that we report may be related to the surgery and it may gradually abate further out from surgery.…”

“…We have previously reported the unexpectedly high 40.7% to 70.7% rate of lower urinary tract pain in the urethral stricture population, which was more pronounced in younger men. 3 Importantly, significant improvements in pain occur in 64% to 73.5% of these patients after successful repair. Our current series demonstrates that pain can sometimes exist/persist after successful repairs and it may also impact patient satisfaction.…”

“…1,2 These symptoms are often accompanied by a history of recurrent urinary tract infections and dysuria or lower urinary tract pain. 3,4 Importantly, such symptoms have been shown to negatively affect quality of life in men with USD. 5,6 …”

“…11,12 Our research group previously noted that successful urethroplasty can improve dysuria and voiding pain. 3 Others have found that urethroplasty can result in improved patient reported LUTS and improved quality of life. 13,14 …”

The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty

“…9 Important factors not typically included in a voiding PROM include urethral and bladder pain, which have a higher incidence in men presenting with urethral strictures than previously thought. 17 The superior performance of the “QOL from urinary symptoms” question of the IPSS in detecting cystoscopic recurrence relative to the individual questions may stem from its ability to represent these often unmeasured factors.…”