Abstract: PD34-07
Sources of Funding: none

Introduction

Although urethroplasty for the treatment of urethral stricture disease provides excellent functional outcomes, the associated postoperative morbidity remains underreported. The purpose of this study was to report and classify postoperative complications utilizing the Clavien-Dindo classification system in comparison to those reported from a variety of other common urological surgical procedures.

Methods

A retrospective review of over 1000 urethroplasty cases by a single surgeon from 2007-2014 was performed. Complications <90 days after surgery were identified and grouped by Clavien-Dindo classification (minor Clavien 1-2, and major Clavien 3-5). Clinical characteristics and outcomes were compared between men with and without complications. Mutivariable logistic regression models assessed risk factors associated with postoperative complications.

Results

Of the 573 procedures reviewed, 121 complications occurred in 107 (18%) procedures within 90 days of urethroplasty. Complications included 70 (12%) minor (Clavien 1-2) and 37 (6%) major (Clavien 3-5) (Table 1). In comparison to other urologic procedures, the complication rate of urethroplasty was similar to other reconstructive procedures such as pyeloplasty. Treatment failure was more common in men who experienced a <90 day complication (39% vs 15%, p<0.0001). Per procedure, the most common complications included: urinary tract infection (N=21, 4%), wound complication (N=16 , 3%), acute urinary retention (N=13, 2%), refractory bladder spasms (N=13, 2%), and urine leak (N=11, 2%). Median time to complication was 26 days (IQR 17-40). Men experiencing a any <90 day complication were more likely to have a history of radiation (28% vs 18%, p=0.04), benign prostatic hyperplasia (BPH) (28% vs 18%, p=0.04), and undergo substitution urethroplasty relative to excision primary anastomosis and urethrostomy (23% vs 18% vs 6%, p=0.03). There was no difference in stricture length, location, prior endoscopic procedures, age, or other comorbidities. On multivariable analysis, substitution urethroplasty (OR 1.68, 95%CI 1.04-2.68; p=0.03) and BPH (OR 1.90, 95%CI 1.02-3.43; p=0.04) were associated with risk of any postoperative complication. Meanwhile, history of radiation therapy (OR 3.12, 95%CI 1.29-8.63; p=0.03) and BPH (OR 4.50, 95%CI 1.89-10.55; p=0.0009) were independently associated with risk of major complications.

Conclusions

Relative to other surgical procedures, urethroplasty has acceptable complication rates with a low incidence of major complications similar to that reported after pyeloplasty. Risk factors for complications include substitution urethroplasty and radiation.

Funding

none