Introduction

Surveillance protocols after bulbar urethroplasty vary. Flexible cystourethroscopy allows for direct visualization of the repair and is often used for surveillance. However, repeated cystourethroscopy following urethroplasty is costly and has significant patient burden. We evaluate the use of single cystourethroscopy performed in the early post-operative period and its ability to predict clinical success in men who underwent bulbar urethroplasty.

Methods

We identified patients from TURNS database from 1/1/2010-3/31/2016, who underwent urethroplasty for isolated bulbar strictures and received surveillance cystourethroscopy within 6 months of their procedure. We excluded patients with history of previous urethroplasty, lichen sclerosus, radiation, failed hypospadias repair, and any patients with clinical recurrence prior to surveillance cystourethroscopy. Our primary outcome was utility of cystourethroscopy findings (normal caliber, >17 French strictured rings, or inability to pass scope [<17 French strictured rings]) in predicting risk of clinical recurrence._x000D_

Results

844 patients were identified. Mean age and BMI was 43 years (SD:15.5) and 30.0 kg/m2 (SD:6.6), respectively. 41 (5%) patients had a history of diabetes. 42 (5%) patients were current smokers and 72 (9%) were former smokers. 648 (77%) had excision and primary anastomosis and 196 (23%) had substitution urethroplasty with buccal graft. Mean operative stricture length was 3.0 cm (SD:1.8). Median time to first post-operative cystourethroscopy was 3.6 months (IQR: 3.1, 4.0). On cystourethroscopy, 608 (72%) had normal findings, 134 (16%) had >17 French strictured rings, and 102 (12%) had <17 French strictured rings. A total of 32 (4%) patients required a secondary procedure at a median time of 2.05 (IQR: 0.1-10.8) months. Cumulative 1-year rate for secondary procedures for recurrence were 0.01 (95% CI: 0-0.03) for normal urethra on first cystourethroscopy, 0.06 (95% CI: 0-0.13) for >17 French strictured rings, and 0.27 (95% CI: 0.13-0.39) for <17 French strictured rings (Figure).

Conclusions

Repeated cystourethroscopy has limited use after bulbar urethroplasty in predicting clinical failure in patients with normal caliber urethra on single early surveillance cystourethroscopy.

Funding

None