Abstract: PD60-01
Sources of Funding: None

Introduction

Urethroplasty is usually a definitive treatment for recurrent urethral stricture. However, patients often wait a significant period of time for urethroplasty, especially in a universal healthcare system, and may incur further risk of complications due to urethral stricture. The purpose of this study is to examine the incidence and predictors of complications due to urethral stricture in patients awaiting urethroplasty.

Methods

A retrospective review of patients undergoing urethroplasty from Sept 2009-2013 in a single center was performed. Patients treated outside of the regional health authority were excluded to minimize unidentified complications and interventions. The primary outcome was complication due to urethral stricture, defined as any unplanned intervention with the health care system during the period between decision to perform surgery and urethroplasty date. These complications included urinary tract infection (UTI), urolithiasis, acute urinary retention, genitourinary pain related to stricture, and catheter-related issues.

Results

276 patients met study criteria. Mean stricture length was 4.5 cm, and most strictures were bulbar (67.4%) or penile (15.2%) in location. Idiopathic (47.8%), traumatic (15.9%), and iatrogenic (10.9%) were the most common stricture etiologies. Overall, 44 (15.9%) patients presented with a complication with a mean time to complication of 65.9 days. The mean surgical wait time was 164 days. Complications included urinary tract infection (56.8%), acute urinary retention (20.5%), genitourinary pain requiring intervention (5.8%), and catheter related events (15.9%). Univariate analysis for factors predicting complications yielded catheter dependency (clean-intermittent catheterization or suprapubic catheter)(p<0.001) and number of prior endoscopic treatments (p=0.005) as significant, with prior urethroplasty (p=0.06) trending towards significance. Multivariate Cox regression analysis found catheter-status (p<0.001; H.R. 2.3, 95% CI:1.5-3.4) and prior urethroplasty (p=0.013; H.R. 1.7, 95% CI: 1.1-2.5) to be significantly associated with complications.

Conclusions

Our study is the first to examine and quantify the morbidity of urethroplasty wait times. Approximately 16% of patients presented with a complication while awaiting urethroplasty at a mean of 66 days after the decision for surgery. Urethroplasty wait time should be less than 66 days and patients whom are catheter dependent or failed prior urethroplasty should be prioritized, as they are more likely to develop complications.

Funding

None