Increasing age, hypospadias tied to LUTS failure after urethroplasty

Voiding function improves in most patients following urethroplasty, but a few of them experience “lower urinary tract symptoms (LUTS) failure” while others report urinary quality of life (UQOL) nonresponse, a study has shown.

“Both occurrences are independently associated with increasing patient age and most commonly related to detrusor underactivity,” the authors said.

Patients undergoing urethroplasty over a 6-year period were asked to participate in a prospective study that assessed urinary function after urethroplasty. The authors examined patients 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. The association between patient factors and LUTS failure was examined using multivariable logistic regression.

Significant improvements were noted in mean postoperative IPSS (20.3 vs 5.4; p<0.0001) and median UQOL (5 vs 1; p<0.0001) in 365 patients who met the eligibility criteria. However, 7.7 percent and 10.1 percent of patients reported LUTS failure and UQOL nonresponse, respectively, despite being stricture-free.

Multivariable logistic regression analysis revealed that increasing age (odds ratio [OR], 1.04, 95 percent confidence interval [CI], 1.01–1.06; p=0.006) and hypospadias (OR, 18.2, 95 percent CI, 2.01–156.0; p=0.008) correlated with LUTS failure, but 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 aetiologies did not.

Qualitatively, detrusor underactivity (39.3 percent), overactivity (21.4 percent), pelvic floor dysfunction (21.4 percent), or benign prostatic hyperplasia (14.3 percent) were the most probable cause of LUTS failure. On the other hand, only increasing age correlated with UQOL nonresponse (OR, 1.03, 95 percent CI, 1.01–1.07; p=0.02).