Modern urethroplasty offers long-term patency, patient satisfaction

Contemporary urethroplasty delivers high long-term patency and satisfaction to patients undergoing such a procedure, a recent study confirms. Moreover, those with longer stricture, lichen sclerosus, radiation, and infectious aetiologies are at greater risk of stricture recurrence in the future.

Investigators identified patients undergoing urethroplasty from July 2003 to May 2013 with at least 100 months of follow-up. Regional/provincial electronic records were reviewed and telephone interviews were performed to assess long-term outcomes, including stricture recurrence and patient satisfaction. Variables associated with long-term stricture recurrence were evaluated using Cox regression.

Urethroplasty failure was defined as a cystoscopy-confirmed stricture recurrence (<16 F).

Some 733 patients (median age 45 years, stricture length 4.7 cm) were included in the analysis, with at least 100 months of follow-up. Of these, 85.8 percent had failed prior endoscopic treatment.

Eighty-nine recurrences occurred over a median follow-up of 12.3 years. The cumulative incidence of stricture recurrence was 6 percent after 1 year, 10 percent after 5 years, and 12 percent after 10 years. Of the patients, 89 percent reported satisfaction with the outcome of the surgery.

Multivariable analyses revealed the independent association of the following factors with stricture recurrence: increasing stricture length (hazard ratio [HR], 1.1, 95 percent confidence interval [CI], 1.05‒1.15; p<0.001) and stricture aetiology (p<0.001), particularly lichen sclerosus (HR, 4.46, 95 percent CI, 2.25‒9.53), radiation (HR, 4.25, 95 percent CI, 1.65‒10.9), and infectious strictures (HR, 5.27, 95 percent CI, 2.03‒13.7).