There is a paucity of reported long-term outcomes after contemporary urethroplasty. Our objective is to determine the long-term success of modern urethroplasty and identify factors associated with stricture recurrence in this context.
Patients undergoing urethroplasty from 07/2003 to 05/2013 with at least 100 months follow-up were identified. Long-term outcomes including stricture recurrence and patient satisfaction were evaluated by review of regional/provincial electronic records and telephone interview. Urethroplasty failure was defined as a recurrent stricture (< 16 Fr) confirmed on cystoscopy. Cox regression was used to evaluate variables associated with long-term stricture recurrence.
733 patients were identified with ≥ 100 months follow-up. Median patient age was 45 years, stricture length was 4.7 cm, and 85.8% failed prior endoscopic treatment. At a median follow-up of 12.3 years, 89 recurrences were observed. Cumulative incidence of stricture recurrence was 6%, 10% and 12% after 1, 5 and 10 years. From a patient-reported perspective, 89% of patients reported being satisfied with the outcome of surgery. On multivariable analyses, increasing stricture length (Hazard Ratio 1.1, 95% CI 1.05-1.15; P < .001) and stricture etiology (P < .001) in particular lichen sclerosus (HR 4.46 95% CI 2.25-9.53), radiation (HR 4.25 95% CI 1.65-10.9) and infectious strictures (HR 5.27 95% CI 2.03-13.7) were independently associated with stricture recurrence.
This study affirms the widely-held belief that modern urethroplasty provides high long-term patency and patient-reported satisfaction. Patients with longer strictures as well as those with lichen sclerosus, radiation and infectious etiologies have a higher hazard of stricture recurrence in the long-term.
The Journal of urology. 2023 Dec 18 [Epub ahead of print]
Carlos Ignacio Calvo, Kai Fender, Nathan Hoy, Keith Rourke
Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.