Abstract: PD60-03
Sources of Funding: none

Introduction

We examined the association of urethral stricture complexity at urethroplasty with previous transurethral manipulation including urethral dilation, urethrotomy, and urethral stenting, which are the most commonly performed procedures for treating male urethral strictures but have alarmingly high failure rates.

Methods

We retrospectively reviewed the records of 249 patients with urethral stricture disease who had undergone urethroplasty between 2004 and 2015. Patients with a history of lichen sclerosus, hypospadias, phalloplasty, and/or prior urethroplasty were excluded from analysis. Of the remaining 197 patients, we analyzed the records of 45 patients who had a history of transurethral treatments including self- or office- dilation, urethrotomy with a cold knife or laser, and/or urethral stenting using temporary thermo-expandable stents at least once and whose urethrography results at initial stricture diagnosis and at urethroplasty were available. We considered stricture complexity increased if the number of strictures and/or stricture length on the urethrography at urethroplasty was greater than that at initial diagnosis, and/or if a false passage was newly identified.

Results

Thirty-nine of the patients (87%) had been subjected to urethral dilation, 32 (71%) to urethrotomy, and 13 (29%) to temporary urethral stenting, and 39 (87%) had received repeated and/or multiple kinds of transurethral treatments. Disease duration (defined as the period between the initial stricture diagnosis and urethroplasty) in patients with repeated transurethral treatments (mean 102 months) was more than four times that in patients with a single transurethral treatment (mean 24 months, p = 0.006). Stricture complexity was increased in 22 (49%) and was significantly associated with a history of urethrotomy (p = 0.03), urethral stenting (p = 0.0002), and repeated transurethral treatments (p = 0.01). Notably, twelve (92%) of 13 patients with history of urethral stenting showed increased stricture complexity, and multivariate logistic regression analysis revealed that history of urethral stenting was an independent predictor of increased stricture complexity (OR 13.7, p = 0.01). Of the 22 patients with increased stricture complexity, seven (32%) were forced to change the type of urethroplasty to one more complex than the predicted repair type based on the urethrography at initial diagnosis.

Conclusions

Repeated transurethral manipulation is associated with increased stricture complexity and is potentially counterproductive.

Funding

none