Risk of urethral stricture recurrence increases over time after urethroplasty

Abstract

Objective: To report a single institutional experience with urethroplasty outcomes and success rates at long-term follow up. Methods: A retrospective review was carried out of all urethroplasties performed by a single surgeon from 2000 to 2010. A total of 347 patients underwent urethroplasty during this time period, of which 227 had minimum 1-year follow-up data available. Demographic, clinical, pathological and outcome data were reviewed. Recurrence was defined by patient reported urinary symptoms or need for subsequent intervention. Statistical analyses were carried out using SPSS statistical software. Results: A total of 26% of all patients had a recurrence at a mean follow up of 62 months (range 13-147 months). The recurrence rate after anastomotic urethroplasty was 18%, as compared with 31% after substitution urethroplasty. Mean time to recurrence was 34 months (range 5-87). On univariate analysis, use of abdominal skin graft, history of prior urethroplasty, lichen sclerosus and length of follow up were statistically significant predictors of recurrence. On multivariate analysis, only history of prior urethroplasty and length of follow-up time exceeding 48 months were statistically significant predictors of recurrence. Conclusions: Urethroplasty for urethral stricture is the most durable treatment modality, regardless of surgical approach. However, there is an ongoing risk of recurrence with the passage of time. Patients should be counseled appropriately on the potential for late recurrence of stricture disease after urethroplasty.

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.…”

“…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. 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. The clinical characteristics of the 29 patients are shown in Table S1.…”

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

“…The present article by Han et al examines risk factors for stricture recurrence in a cohort of 227 patients undergoing anterior urethroplasty with a mean follow up of 62 months. 1 Patients with radiation or pelvic facture-related stenosis as well as panurethral strictures were excluded from the study. In this series, 26% of patients experienced stricture recurrence during follow up.…”

“…1 However, there is no consensus about the follow-up strategies or the optimal intervals between and durations of follow up after urethroplasty. 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.…”