MP22-16: Affirming Long-Term Stricture-Free Rates and Patient Satisfaction after Urethroplasty: The Negative Impact of Panurethral, Lichen Sclerosus, Radiation and Infectious Strictures

Kai Fender, Keith Rourke*, Nathan Hoy, Edmonton, Canada

Introduction: Urethroplasty, is thought to be the most efficacious treatment for establishing urethral patency and improving patient quality of life. While performed with the intention of providing long-term relief in stricture-associated obstruction, there is a paucity of reported long-term urethroplasty outcomes. Our objective is to determine the long-term success (=100 months) of urethroplasty and identify factors associated with stricture recurrence in this context.

Methods: Patients undergoing urethroplasty from July 2003-May 2013 with at least 100 months’ follow-up were reviewed. Long-term outcomes including stricture recurrence and patient satisfaction were assessed by review of regional/provincial electronic records and patient telephone interview. Urethroplasty failure was defined as a recurrent stricture ( <16Fr) confirmed on cystoscopy. Potential factors examined for stricture recurrence were patient age, stricture etiology, stricture length, diabetes, smoking, obesity, number of previous endoscopic treatments, prior urethroplasty, urethral transection and type of urethroplasty. Multivariable Cox regression analysis was used to evaluate potential associations with long-term stricture recurrence.

Results: 733 patients were identified with =100 months follow-up after urethroplasty. Mean patient age was 44.6 years, mean stricture length was 4.7 cm, 85.8% failed prior endoscopic treatment and 19.5% had prior urethroplasty. Most common stricture etiologies were idiopathic (38.6%), traumatic (24.7%), hypospadias (10.2%) and lichen sclerosus (10.1%). At a mean follow-up of 150.6 months, urethroplasty success was 87.9%. Mean time to stricture recurrence was 27.0 months with recurrences identified as late as 158 months. From a patient-reported perspective, 87.8% of patients reported being satisfied with the outcome of surgery and 91.8% would undergo surgery again if required. On multivariable analyses, increasing stricture length (Hazard Ratio 1.12, 95%CI 1.05-1.17; p<0.0001) and panurethral strictures (47.2%, H.R. 2.98, 95%CI 1.12-7.94; p=0.03) were associated with higher rates of stricture recurrence as well as stricture etiology in particular lichen sclerosus (33.8%, H.R. 3.53, 95%CI 1.52-8.20; p=0.003), radiation (19.4%, H.R. 3.84, 95%CI 1.43-10.27; p=0.007) and infectious strictures (28.6%, H.R. 4.41; 1.65-11.78; p=0.003). Diabetes (p=0.54), obesity (p=0.17), prior urethroplasty (p=0.22), urethral transection (p=0.82), type of urethroplasty (p=0.88) and other stricture etiologies or locations were not associated with stricture recurrence.

Conclusions: This study affirms that the majority of patients undergoing urethroplasty have high long-term stricture-free rates and patient-reported satisfaction. Patients with longer strictures in particular those with pan-urethral strictures as well as patients with lichen sclerosus, radiation and infectious strictures have higher rates of long-term stricture recurrence.

Source of Funding: 2021 Alberta Innovates Summer Research Studentship (SRS)