Introduction: Genital pain is an exceedingly common urological condition with a probable but unclear association with urethral stricture. The objective of this prospective study is to assess the incidence of genital pain in patients with urethral stricture and examine the impact of urethroplasty.
Methods: Over a 7-year period (2011-2018), patients were offered enrollment in a prospective single-centre study assessing patient-reported genital pain pre- and 6-months post-urethroplasty. Genital pain was assessed with the question, “Do you experience genital (scrotal or penis) pain?” answered on a five-point scale [“Never” (1), “Occasionally” (2), “Sometimes” (3), “Most of the Time” (4) or “All of the Time” (5)]. Responses of 3, 4, or 5 were considered clinically significant. Descriptive statistics were used to summarize findings, Wilcoxon signed-rank test was used to compare pre- and post-operative states and logistic regression was used to evaluate the association between genital pain and clinical variables.
Results: 387 patients completed enrollment with a mean age of 49.5 years and stricture length of 4.5cm. Pre-operatively, 36.4% (141/387) of patients reported genital pain with overall responses of 5.7% “all of the time”, 9.8% “most of the time”, 20.9% “sometimes”, 29.7% “occasionally” and 33.9% “never”. Patients with panurethral stricture reported significantly higher rates (57.1%) of pre-operative pain (Odds Ratio 2.93, 95%CI 1.32-6.50; p=0.008) while others factors were not (including age (p=0.07), stricture length (p=0.08), etiology (p=0.43), number of endoscopic treatments (p=0.52), and prior urethroplasty (p=0.42)). Overall, pain scores improved post-urethroplasty (p < 0.0001) with responses of 1.0% “all of the time”, 3.6% “most of the time”, 9.6% “sometimes”, 21.2% “occasionally”, and 64.6% “never”. Specifically, in those reporting pre-operative genital pain, 88.7% (125/141) experienced improvement (p < 0.0001), 8.5% were unchanged and 2.8% reported worse pain. On logistic regression analysis patients with penile strictures (O.R. 0.24, 95%CI 0.06-0.91; p=0.04), hypospadias (O.R. 0.14, 95%CI 0.02-0.88; p=0.04), and staged reconstruction (O.R. 0.22, 95%CI 0.05-0.90; p=0.04) were less likely to report improvement in genital pain (80.0%, 76.5% and 69.2% respectively). No identifiable clinical factor was associated with worsening pain. In the entire study cohort, 50.4% reported improvement in genital pain after urethroplasty, 37.0% were unchanged and 12.7% reported worsening pain. In the overall cohort, patients undergoing staged reconstruction were again less likely to report an improvement in genital pain status (O.R. 0.49, 95%CI 0.26-0.95; p=0.04) with no factor associated with worsening of genital pain post-urethroplasty.
Conclusions: Genital pain is common in patients presenting with urethral stricture and more common in those with panurethral stricture. While the exact mechanism remains to be determined, genital pain improves in the majority of patients undergoing urethroplasty but less so in patients with penile strictures, hypospadias and staged reconstruction.
Source of Funding: Northern Alberta Urology Foundation
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.jpg "Keith Francis Rourke, MD photo")