Revision urethroplasty success is comparable to primary urethroplasty: a comparative analysis.

OBJECTIVE: To assess the efficacy and complications of revision urethroplasty compared with urethroplasty-naïve controls. MATERIALS AND METHODS: A retrospective analysis was performed of 534 urethroplasties performed by a single surgeon from August 2003 to March 2011. Patient age, stricture length, location, etiology, comorbidities, and type of surgery were recorded. Statistical comparison between the revision cohort and urethroplasty-naïve group were made using Fisher, χ(2), and unpaired t tests, with significance at P < .05 (2-tailed). The primary outcome was urethral patency assessed by cystoscopy. Secondary (subjective) outcome measures included erectile dysfunction, pain, urinary tract infection, or chordee at 6 months. RESULTS: A total of 476 patients met inclusion criteria with completed cystoscopic follow-up. Previous urethroplasty had failed in 49 patients (10.3%). Patients undergoing revision urethroplasty were more likely to have stricture in the penile urethra (22.4%; P = .001), to have strictures exceeding 4 cm in length (71.4% vs 54.3%; P = .023), and to require tissue transfer (83.6% vs 65.1%; P = .010). Urethral patency rates did not differ significantly between naïve and revision urethroplasty cohorts, with a mean follow-up of 49.9 months (94.6% vs 91.8%; P = .518). The revision group had a higher incidence of chordee (2.7% vs 14.3%; P = .001) and urinary tract infection (3.5% vs 10.2%; P = .04). The rates of erectile dysfunction, scrotal pain, lower urinary tract symptoms, and incontinence did not differ significantly between the 2 groups. CONCLUSION: Revision urethroplasty is an effective treatment option for recurrent stricture after urethroplasty and is comparable to results in urethroplasty-naïve patients. Patients undergoing revision urethroplasty are more likely to require tissue transfer and experience higher rates of chordee and urinary tract infection.

Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties.

INTRODUCTION: We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty. METHODS: We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr on cystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression. RESULTS: In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence. CONCLUSION: Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.