Urinary Symptom Nonresponse (“LUTS Failure”) after Urethroplasty: Incidence and Associations

Abstract

Purpose:An ill-defined proportion of patients undergoing urethroplasty fail to experience improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence, associations and causes of “LUTS failure” after urethroplasty.Materials and Methods:Patients undergoing urethroplasty over a 6-year period were offered enrollment in a prospective study examining urinary function after urethroplasty. Patients were assessed preoperatively and 6 months postoperatively using the International Prostate Symptom Score (IPSS) and cystoscopy. “LUTS failure” was defined as ≤3-point improvement in IPSS despite an anatomically successful urethroplasty. Multivariable logistic regression was utilized to evaluate the association between patient factors and “LUTS failure.”Results:Of 365 patients meeting inclusion criteria, mean postoperative IPSS (20.3 vs. 5.4, p <0.0001) and median urinary quality of life (UQOL; 5 vs. 1; p <0.0001) were significantly improved. Despite being stricture-free, 7.7% of patients reported “LUTS failure” and 10.1% reported UQOL nonresponse. On multivariable logistic regression, increasing age (OR 1.04, 95% CI 1.01–1.06; p=0.006) and hypospadias (OR 18.2, 95% CI 2.1–156.0; p=0.008) were associated with “LUTS failure,” while stricture location (p=0.76), length (p=0.14), previous urethroplasty (p=0.96), failed endoscopic treatment (p=0.17), type of urethroplasty (p=0.93) and other etiologies were not. Qualitatively, the most likely causes of “LUTS failure” were detrusor underactivity (39.3%), overactivity (21.4%), pelvic floor dysfunction (21.4%) or benign prostatic hyperplasia (14.3%). Only increasing age was associated with UQOL nonresponse (OR 1.03, 95% CI 1.01–1.07; p=0.02).Conclusions:While many patients experience improved voiding function after urethroplasty, 7.7% experience “LUTS failure” and 10.1% report UQOL nonresponse. Both occurrences are independently associated with increasing patient age and most commonly related to detrusor underactivity.

Ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly

“…The time taken to perform spinal anesthesia in group PM was significantly shorter than group M (P < 0.05), but was not different from group P. The number of needle redirections in group PM (1[0-2]) was significantly fewer than group M (2[1-3.25], P < 0.05), but there was no statistically significant difference with group P (1 [1][2]). The patient satisfaction score during the process of puncturing was higher in group PM (4 [4][5]) than groups M (4 [3][4], P < 0.05) or P (4[3.5 -4], P < 0.05). Compared with group M, the time taken to perform spinal anesthesia in group P was significantly reduced (P < 0.05), and the other related data during puncturing showed no statistical significance.…”

“…Studies have shown that the risk of many urinary system diseases (such as benign prostatic hyperplasia, bladder tumors, or urethral stricture) increase drastically with ageing. Even for patients who have undergone urethroplasty, the decline of detrusor function related to age may cause repeat urinary difficulties [2][3][4]. Compared with general anesthesia, spinal anesthesia has been recognized as providing greater hemodynamic stability, higher patient satisfaction, lower rate of opioid use, higher rate of opioid-free recovery, and lower maximum Post-Anesthesia Care Unit (PACU) pain scores [5][6][7].…”

Current perspectives in hypospadias research: A scoping review of articles published in 2021 (Review)

“…Reoperation rate after distal hypospadias repair ranges from 3.3-6.7% (106,107). Other related complications are penile curvature that appears in 25% of cases (>30˚) (43,102,108-110), hairy urethra (111,112), erectile dysfunctions (113,114) and lower urinary tract symptoms (115). There were similar complications every surgeon is acquainted with.…”

The exploration of ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly

“…In the context of the increasingly prominent trend of population aging, the number of elderly who need surgical treatment under spinal anesthesia is increasing.Even the mean age of the spinal anesthesia cohort for Hip Fracture Repair demonstrated a similar increasing trend over time whereas the mean age of the general anesthesia cohort did not [1] .Studies have shown that the risk of most many urinary system diseases (such as benign prostatic hyperplasia, bladder tumors, urethral stricture, etc. ) increase drastically with ageing,even for patients who have undergone urethroplasty, the decline of detrusor function related to age may cause urinate di culty again [2][3][4] .In some cases,compared with general anesthesia, spinal anesthesia has been recognized by the majority of anesthesiologists because of providing greater hemodynamic stability, higher patients' satisfaction, lower rate of opioid use and higher rate of opioid-free recovery and lower maximum PACU pain scores [5][6][7] .…”

“…(2[1-3.25], P<0.05),but compared with group P (1[1][2]) ,the difference was not statistically signi cant; In terms of patient satisfaction score during the process of puncturing, group PM (4[4][5]) was respectively higher than groups M (4[3][4], P<0.05) and P (4[3.5 -4], P<0.05).…”