Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol

Abstract

Purpose:A successful urethroplasty has been defined in different ways across studies. This variety in the literature makes it difficult to compare success rates and techniques across studies. We aim to evaluate the success of anterior urethroplasty based on different definitions of success in a single cohort.Materials and Methods:Data were collected from a multi-institutional, prospectively maintained database. We included men undergoing first-time, single-stage, anterior urethroplasty between 2006 and 2020. Exclusion criteria included lack of followup, hypospadias, extended meatotomy, perineal urethrostomy, posterior urethroplasty and staged repairs. We compared 5 different ways to define a “failed” urethroplasty: 1) stricture retreatment, 2) anatomical recurrence on cystoscopy, 3) peak flow rate <15 ml/second, 4) weak stream on questionnaire and 5) failure by any of these measures. Kaplan-Meier survival curves were generated for each of the definitions. We also compared outcomes by stricture length, location and etiology.Results:A total of 712 men met inclusion criteria, including completion of all types of followup. The 1- and 5-year estimated probabilities of success were “retreatment,” 94% and 75%; “cystoscopy,” 88% and 71%; “uroflow,” 84% and 58%; “questionnaire,” 67% and 37%; and “any failure,” 57% and 23%. This pattern was inconsistent across stricture length, location and etiology.Conclusions:The estimated probability of success after first-time, anterior urethroplasty is highly dependent on the way success is defined. The variability in definitions in the literature has limited our ability to compare urethroplasty outcomes across studies.

Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm

“…Formal comparison of patency rates between urethroplasty techniques is challenging, as most published studies are retrospective cohorts and thus confounded by non-random patient selection for a given approach. The situation is further complicated by the varying definitions of “success” used and length of follow-up, which can affect the true efficacy of urethroplasty and makes comparisons between studies difficult ( Table 1 ) [ 33 ]. The available data broadly suggest similar patency rates between transecting and non-transecting techniques in the bulbar urethra [ 17 , 18 , 19 ].…”

Affirming Long-Term Outcomes After Contemporary Urethroplasty: The Adverse Impact of Increasing Stricture Length, Lichen Sclerosus, Radiation, and Infectious Strictures

“…There is still a lack of consensus on how often to perform follow-up after urethroplasty and how to define success after urethroplasty. 16,17 While performing a cystoscopy or urethrogram is probably the most objective way to assess patency, the finding of a recurrence, even of small caliber, may be of unclear clinical significance. 18 Uroflowmetry has also been described after urethroplasty with some clinical utility, but this practice remains controversial as urine flow may not be impaired until substantial stricture recurrence occurs and may be further confounded in patients with concurrent benign prostatic hyperplasia or detrusor dysfunction.…”

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

“…Follow-Up, Objective Results, and Subjective Patient-Reported Outcomes Patients were contacted personally for cross-sectional follow-up by telephone and mail, and digital patient charts (Soarian Clinicals â ) were additionally reviewed for re-admissions and repeat visits to our institution. Objective treatment success was defined as functional success, i.e., symptomatic need of any instrumentation (dilatation, endoscopic, or reconstructive surgery during follow-up) [25]. Subjective, patient-reported treatment outcomes were assessed by the aforementioned PROMs, as well as a generic treatment satisfaction question [19].…”

“…The six-item LUTS score, as derived from the USS PROM, significantly improved from a baseline median (IQR) score of 13 (8)(9)(10)(11)(12)(13)(14) to postoperative median (IQR) score of 3.5 (1-8) (P < 0.001). In sexually active patients, there were no differences in the median baseline vs postoperative IIEF-EF scores (median [IQR] 27 [17][18][19][20][21][22][23][24][25][26][27][28][29][30] vs 24 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]; P = 0.4). Similarly, no differences were found in the median ICIQ-UI sum scores (median [IQR] 0 [0-8] vs 0 [0-7]; P = 0.5).…”