Login to Access Video or Poster Abstract: MP79-17
Sources of Funding: none

Introduction

Up to one-third of men undergoing urethroplasty have strictures of unknown etiology. Little data exists defining the clinical characteristics and outcomes of urethroplasty in this population. We hypothesized that idiopathic strictures may be the result of unrecognized remote urethral trauma. The aim of this study was to compare stricture characteristics and surgical outcomes of men with idiopathic strictures to those with an identified etiology in an effort to delineate the nature of this common, yet poorly understood entity.

Methods

We retrospectively reviewed our urethroplasty database of over 1200 cases performed from 2007-2016 to identify those men undergoing first-time urethroplasty. Patients were stratified by urethral stricture etiology including radiation, trauma/iatrogenic, hypospadias, balanitis xerotica obliterans, and idiopathic. Idiopathic strictures were defined by absence of any identified etiology. Only cases with at least 2 years follow-up were included in this analysis.

Results

Of the 434 patients with urethral strictures undergoing first-time urethroplasty having complete data available, more than one-third were identified as being idiopathic (165/434, 38%). When compared to other stricture etiologies (Table 1), men with idiopathic strictures were remarkably similar to traumatic/iatrogenic strictures in terms of age, stricture length, location, and surgery. The majority of idiopathic strictures presented in younger men (median 48 years), were confined to the bulbar urethra (153/166, 92%), and had a median length of 2 cm. The most common procedure was excision and primary anastomosis (EPA) (123/165, 74%) and only 19 (11%) men with idiopathic strictures experienced primary urethroplasty failure. Compared to strictures with identified etiology, men with idiopathic strictures underwent more pre-urethroplasty endoscopic interventions and had a greater delay between diagnosis and surgery. Estimated 24-month stricture recurrence-free survival was similar to traumatic strictures (79% vs 77%) with radiation and hypospadias having a much higher risk of failure.

Conclusions

Stricture characteristics and outcomes of idiopathic urethral strictures are similar to those of traumatic strictures, suggesting that unrecognized trauma may contribute to idiopathic stricture formation. Although definitive treatment of idiopathic strictures tends to be delayed, they have a high rate of urethroplasty success because most are short bulbar strictures amenable to EPA.

Funding

none