Login to Access Video or Poster Abstract: MP36-16
Sources of Funding: None

Introduction

Recurrent urethral strictures following open urethral reconstruction can be challenging. We sought to determine the efficacy of salvage direct visualization internal urethrotomy (DVIU), and/or steroid injection in the post-urethroplasty setting, and to identify risk factors for subsequent failure.

Methods

We identified all patients (n=101) from two institutions who failed urethroplasty and underwent salvage DVIU. Triamcinolone (400mg) was injected intra-spongiosal in 86 patients at the time of the DVIU. The primary outcome of stricture recurrence was defined as need for an additional urethral procedure and inability to pass a 16 French flexible cystoscope. Baseline demographic and stricture characteristics for those with and without recurrence were compared using t-test, Chi square, and Mann-Whitney test where applicable. Univariable and multivariable logistic regression was performed to identify factors associated with salvage DVIU failure.

Results

Median age at DVIU among all patients (n=101) was 45.0 years (interquartile range [IQR] 35-57). Pre-urethroplasty stricture location was bulbar (n=82, 81.1%), bulbo-membranous (n=11, 10.9%), penile (n=5, 5.0%), and panurethral (n=3, 3.0%). Recurrent stricture length was 1.1 cm (mean). DVIU success rate was 68.3% with median follow-up of 44.5 months (IQR 21-75). Median maximum flow rate and International Prostate Symptom Score (IPSS) before and 6 months after DVIU was 7 vs 12 cc/s and 10 vs 6, respectively. Diabetes, smoking, age or initial stricture location had no association with salvage DVIU success. Patients with DVIU failure were less likely to have received triamcinolone vs. those without recurrence (75.0% vs 89.9%, p=0.05). On multivariable analysis, triamcinolone trended towards protection against recurrence, with an odds ratio [OR] 0.34, p=0.08. Patients without recurrence showed a trend towards greater improvement in IPSS at 6 months (-5 versus -1, p=0.88).

Conclusions

Conclusions: Salvage DVIU of short recurrent strictures after urethroplasty is moderately effective. Baseline demographic and stricture characteristics are poor predictors of success, while triamcinolone injection may add efficacy to DVIU.

Funding

None