Login to Access Video or Poster Abstract: MP36-06
Sources of Funding: none

Introduction

Choice of urethroplasty technique is usually dictated by patient and surgeon preference, as well as the stricture length and location, as determined by retrograde urethrogram. Unlike oncologic surgeries, stricture pathology rarely dictates treatment choice. Furthermore, at our institution, urethral tissue sent during urethroplasty is not routinely analyzed for anything more than malignant change, nor is it routinely used to determine the chance of stricture recurrence. The purpose of this study was to retrospectively review urethral stricture pathology specimens for the presence of inflammation. We hypothesized that re-review of the slides would reveal significant specimen heterogeneity and that the degree and type of inflammation would predict for stricture recurrence.

Methods

Pathology from bulbar urethroplasties performed from 2010 to 2016 by one of two surgeons at a single institution were retrospectively reviewed. Original pathology reports were compared to reports provided on re-review by a single GU pathologist for the presence, type and degree of inflammation within the specimen as well as the presence of lichen sclerosus. Surgical outcomes were then compared to the updated pathologic findings.

Results

Of 181 bulbar urethroplasties performed in the study period, only 95 (52.4%) had tissue collected for pathologic analysis. Comparisons of original and re-review of pathology slides revealed increases in reported lymphocytic inflammation (25.3% vs 42.1%; p=0.02), squamous metaplasia with hyperkeratosis (12.6% vs 33.7%; p = 0.0009), nephrogenic adenoma (3.2% vs. 6.3%; p = 0.5) and lichen sclerosus (2.1% vs 5.3%; p = 0.44). The predominant inflammatory cell type was lymphocytic in 41 cases (B/T cell;43.2%), plasma cell in 5 (5.2%), eosinophilic in 8 (8.4%) and neutrophilic in only 1 (1.1%). Of the 15 (16%) patients noted to have urethroplasty failure, presence and type of inflammation was not significantly greater versus those with successful repairs (p=0.57).

Conclusions

Re-review of stricture pathology revealed more inflammation and greater inflammatory heterogeneity than was previously appreciated. While inflammation did not predict for recurrence, our specimen retrieval rates were unacceptably low, especially for substitution urethroplasties, which may have impacted the lack of association. We have since standardized tissue retrieval and analysis protocol which we believe may ultimately be used to elucidate stricture pathophysiology and predict surgical success.

Funding

none