Introduction: Preoperative oral health is rarely considered when deciding treatment for urethral stricture disease. However, our previous pilot study of 51 patients and 37 grafts, demonstrated that preoperative oral health impacts oral graft (OG) histology and therefore, may affect urethroplasty success (J Urol., Sept 2021). We aimed to evaluate if oral health and OG histology impacts the risk of stricture recurrence following OG urethroplasty.
Methods: All patients who underwent OG urethroplasty from July 2018-Sept 2021 with completed preoperative oral health surveys: patient-completed Oral Health Impact Profile (OHIP14) and provider-completed Kayser-Jones Brief Oral Health Status Examination (BOHSE), were included. A staff pathologist analyzed OG histology and quantified oral mucositis (OM). Stricture recurrence was defined as a need for a second operative intervention for stenosis. Kaplan Meier (KM) curves and Cox proportional hazard ratios assessed the impact of OG histology and preoperative oral health on recurrence risk within 2 years of surgery.
Results: 89 patients (mean age: 47.9 years) and 111 harvested grafts were included. 70 grafts were reviewed in pathology. 51% had non-zero BOHSE (45/89) and 25% had non-zero OHIP14 (21/83) scores. Mean follow-up time was 13.1 months. 13% of patients recurred within 2 years. On age-adjusted analysis, increasing BOHSE and OHIP14 were associated with decreasing epithelial thickness (p = 0.01 and p = 0.03) and increasing OM score (p=0.01 and p = 0.045). Increasing BOHSE also correlated with increased graft stretch (p = 0.02). 18% of patients with non-zero BOHSE scores (8/45) recurred within 2 years, compared to 7% with zero BOHSE scores (3/44). Stricture recurrence free survival was not statistically different between these groups (HR 2.8, p = 0.13; Figure 1). Cox proportional analysis also did not identify BOHSE (continuous), epithelial thickness, delta stretch or OM score, as risk factors for recurrence (all p > 0.05).
Conclusions: We re-demonstrated with a larger cohort, that preoperative oral health is associated with changes in OG histology and graft stretch. There appears to be a trend towards a relationship between worse oral health, measured by BOHSE, and risk of urethroplasty failure, however more patients and longer follow-up are likely needed to reach significance.
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