Do previous urethral endoscopic procedures and preoperative self‐dilatation increase the risk of stricture recurrence after urethroplasty?

Abstract

Objective To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self‐dilatation (ISD). Methods Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow‐up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed. Results Overall, 106 patients were included with a median follow‐up of 12 months (interquartile range 8‐13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis. Conclusions This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.

Inflammation indexes and machine-learning algorithm in predicting urethroplasty success

“…Prior endoscopic interventions for urethral stricture are also a well-debated topic for recurrence probability. Studies have proposed that over two prior DVIU interventions lower the success of future urethroplasty [ 7 22 ]. Moreover, guidelines strongly advise not to exceed two repetitive endoscopic procedures if urethroplasty is an option because this increases the complexity of the stricture [ 5 6 ].…”

“…Predictors of success in urethral stricture management have been a popular and well-debated topic due to the recurrence tendency and the drastic symptomatic course of the disease. Stricture length and location, patients’ ages, patient comorbidities such as the presence of obesity or diabetes mellitus, etiology of stricture, presence of previous urethral surgery (direct visual internal urethrotomy [DVIU] or open urethroplasty) or dilatation history, urethroplasty technique or the duration until recurrence have been proposed and discussed thoroughly for projecting the prognosis patients [ 3 7 8 9 10 ]. Lately, based on spongiofibrosis being an end-result of a chronic inflammatory process of the urethral tissue, hematologic profiles of the patients such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were presented in aim to foresee recurrence [ 11 12 13 14 ].…”

Patient reported outcomes of intermittent self‐dilatation after direct vision internal urethrotomy

“…Intermitted self‐dilatation of the urethra (ISD) as an adjuvant treatment after DVIU has been shown to significantly reduce stricture recurrence rates 3 . Despite being an established, guideline recommended treatment modality of urethral strictures for more than two decades, studies of ISD are scarce and limited by small patient cohorts 3–5 . While ISD is generally considered a safe procedure with a low complication rate, it has been reported, that quality of life (QoL) of ISD patients was poor 4 .…”

“…3 Despite being an established, guideline recommended treatment modality of urethral strictures for more than two decades, studies of ISD are scarce and limited by small patient cohorts. [3][4][5] While ISD is generally considered a safe procedure with a low complication rate, it has been reported, that quality of life (QoL) of ISD patients was poor. 4 This contrasts with our clinical impression, where patients seem to benefit from ISD without any negative impact on their QoL.…”

Iatrogenic lipogranuloma of the penis

“…During urethral dilation, sterile paraffin oil is used as a lubricant to prevent urethral injury caused by the urethral dilator. 8 There are two common application methods of paraffin oil as a lubricant in clinical urethral stricture dilation. One method is to spread paraffin oil on the urethral dilator for urethral dilation.…”