Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties

Abstract

Introduction: We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty. Methods: We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr on cystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression. Results: In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence. Conclusion: Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.

U‐score system for predicting time to recurrence after urethral reconstruction in patients with anterior urethral stricture

“…1,4,5 The aim of the present study was to identify whether results obtained with the U-score system are useful to predict time to recurrence, as well as perioperative outcome in patients undergoing an anterior urethroplasty.After approval from the ethics committee of Toho University Faculty of Medicine (M17254), we retrospectively analyzed the database records of 29 male patients who underwent an anterior urethroplasty procedure at our institution from 2011 to 2016. However, recurrence after reconstruction remains the major hurdle to overcome in patients treated for this disease, as its risk surely increases over time after surgery.…”

“…1,4,5 The aim of the present study was to identify whether results obtained with the U-score system are useful to predict time to recurrence, as well as perioperative outcome in patients undergoing an anterior urethroplasty. 2,3 Importantly, the U-score system is based on stricture length, location, stricture number and etiology, 3 each of which might be an independent risk factor for stricture recurrence.…”

Effect of adipose tissue-derived stem cell injection in a rat model of urethral fibrosis

“…5 However, long stricture length (>4-5 cm), lichen sclerosus, infectious or iatrogenic etiologies, prior urethroplasty, and failed endoscopic therapy are risk factors of urethroplasty failure. 6,7 Current adjunctive treatments that aim to improve treatment outcomes include injection of mitomycin c and steroids. [8][9][10] Results of these different treatment options remain inconsistent and, as such, none of these modalities have been widely adopted.…”

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.…”

“…[3][4][5] Lifelong follow up is necessary after substitution urethroplasty, because stricture recurrences can increase with time and occur even after 15 years as a result of the contracture of grafts or flaps.…”