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Independent Predictors of Stricture Recurrence Following Urethroplasty for Isolated Bulbar Urethral Strictures

David Chapman, Adam Kinnaird, Keith Rourke
Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
 DOI: http://dx.doi.org/10.1016/j.juro.2017.05.006

Purpose
We evaluated preoperative risk factors associated with stricture recurrence in a large, homogenous series of bulbar urethroplasties.

Materials and Methods
We analyzed the records of 596 patients who underwent isolated bulbar urethroplasty at a single center from August 2003 to June 2015. Urethroplasty failure was defined as stricture less than 16Fr identified on cystoscopy with a minimum of 12 months of followup. The potential risk factors examined were patient age, stricture etiology, stricture length, diabetes, smoking, obesity, Charlson comorbidity index, previous endoscopic treatment, previous urethroplasty and type of urethroplasty. Univariate and multivariable Cox regression analysis was used to evaluate potential risk factors and associations.

Results
Average stricture length was 3.9 cm and mean patient age was 44.4 years. Overall urethral patency was 93.3% and mean followup was 65.4 months (range 12 to 149). Previous endoscopic treatment had failed in 88.1% of patients while previous urethroplasty had failed in 10.7%. On multivariate analysis increased stricture length (HR 1.2, 95% CI 1.1–1.3, p = 0.01), increased patient comorbidity (HR 2.4, 95% CI 1.1–5.3, p = 0.03), obesity (HR 2.9, 95% CI 1.3–6.5, p = 0.01) and infectious strictures (HR 3.7, 95% CI 1.3–10.6, p = 0.02) were associated with stricture recurrence. Previous urethroplasty, the number of failed endoscopic procedures, type of urethroplasty and individual comorbidities such as diabetes, smoking and patient age did not affect the recurrent stricture rate.

Conclusions
Although bulbar urethroplasty has a good stricture-free rate, patients with increased stricture length, increased overall comorbidity, obesity and strictures of infectious etiology are at higher risk for failure. These patients at risk should be counseled accordingly and perhaps be followed more closely after urethroplasty.

Key Words:
urethral stricture, reconstructive surgical procedures, treatment failure, risk, prognosis

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