Multivariate Analysis of Risk Factors for Long-Term Urethroplasty Outcome

Abstract

Length of urethral stricture (greater than 4 cm), prior urethroplasty and failed endoscopic therapy are predictive of failure after urethroplasty. Smoking and diabetes mellitus also may predict failure potentially secondary to microvascular damage.

The UREThRAL stricture score: A novel method for describing

“…5 As we were trying to develop a descriptive scoring system, we did not include these variables. These variables are certainly important and will likely need to be included in any nomogram that is developed to help determine stricture recurrence risk, along with the USS.…”

“…Using this database to develop the UREThRAL stricture score (USS), we excluded all patients who had posterior strictures or who had a prior open urethroplasty, a known risk factor predictive of failure. 5 Any patient who did not have complete data regarding the type of surgery or stricture characteristics was also excluded. To develop a scoring system that could be easily calculated and memorized, only five key factors were selected for inclusion.…”

Editorial Comment from Dr Rourke to Risk of urethral stricture recurrence increases over time after urethroplasty

“…The factors most often associated with stricture recurrence (in descending order) are prior procedures (urethroplasty or endoscopic), stricture length, smoking and lichen sclerosus. [2][3][4] These risk factors, however, are found in less than half of the studies on the subject. Other occasionally identified factors include diabetes, the use of penile skin grafts, surgical technique (anastomotic urethroplasty), hypospadias, poor oral hygiene and surgeon experience.…”

“…The present study describes the long-term follow up of 347 patients who underwent urethroplasty, evaluates the potential risks for stricture recurrence and concludes that the durations of follow up are an independent predictor of recurrence. 2 The authors advocate that patients should be counseled appropriately on the potential risks of late stricture recurrence after urethroplasty, regardless of surgical procedures.…”

Urethroplasty; Wide Range of Therapeutic Indications and Surgical Techniques

“…Whilest et al [42] found up to two internal urethrotomy did not affect the outcomes or likelihood of subsequent anastomotic urethroplasty in patients with posterior injuries. For the anterior urethra using cox hazards regression analysis, failed internal urethrotomy has been found to conform increased risk of failure for consequent urethroplasty [43]. Morey concluded that carful preoperative evaluation should be undertaken prior to internal urethrotomy and a patient should not need to have failed minimally invasive therapy prior to being considered for urethroplasty [44].…”