Abstract: PD60-02
Sources of Funding: none

Introduction

Bulbar urethral strictures ≤ 2 cm are generally amenable to excision and primary anastomosis (EPA) and associated with excellent outcomes. We hypothesized that men having repeated endoscopic treatments of urethral strictures developed increased spongiofibrosis, thus leading to longer strictures requiring more complex repairs. The objective of this study was to analyze clinical characteristics of patients having bulbar strictures > 2 cm requiring complex repairs in comparison to those with shorter strictures.

Methods

We retrospectively reviewed our urethroplasty database of over 1200 patients from 2007-2016. We identified 365 patients undergoing first-time urethroplasty for bulbar urethral stricture disease with complete data available and at least 2 years of follow-up. Penile strictures and posterior urethral stenosis were excluded. Pretreatment characteristics were evaluated to identify associations with intraoperative bulbar urethral stricture length. A cutpoint of 2 cm was used to identify preoperative characteristics associated with shorter strictures more amenable to EPA versus those requiring substitution urethroplasty.

Results

Of the 365 (64%) primary bulbar urethral strictures treated, 160 (44%) were > 2 cm in length. These longer bulbar urethral strictures > 2 cm (LBUS) were associated with a greater delay between stricture diagnosis and urethroplasty (mean 117 vs 81 months, p=0.01) and greater total number of prior endoscopic interventions (mean 8 vs 3, p=0.005) compared to shorter strictures. Accordingly, LBUS were less likely to undergo EPA relative to those with strictures ≤ 2 cm (64% vs 99%, p<0.0001). When stratified by time from initial diagnosis to definitive urethroplasty (≤ 5 years, 5-10 years, and >10 years), a clear incremental increase was identified in procedures performed (p<0.0001) and stricture length (p=0.004) (Fig 1). Men with strictures >2 cm were more likely to experience urethroplasty failure (18% vs 9%, p=0.01). Specifically, each additional endoscopic stricture incision was associated with a 1.25-fold increased risk of urethroplasty failure (p=0.007). On multivariable analysis, only increasing number of endoscopic interventions (OR 1.02, 95%CI 1.00-1.05; p=0.04) was independently associated with bulbar urethral stricture length >2 cm.

Conclusions

Delay between initial stricture diagnosis and definitive reconstruction is associated with increasing numbers of endoscopic treatments, lengthening of strictures, and greater risk of urethroplasty failure.

Funding

none