Abstract: PD60-12
Sources of Funding: none

Introduction

While urethroplasty remains safe and effective in younger populations, little data exists evaluating outcomes of urethroplasty in elderly men. We report treatment outcomes, complications, and stricture characteristics among men having urethral reconstruction who were ≥ 70 years of age.

Methods

A retrospective review of over 1000 urethroplasty cases by a single surgeon from 2007-2014 was performed to identify elderly men ≥70 years undergoing urethral reconstruction. Men were stratified by age and differences were assessed including stricture characteristics, postoperative complications, and surgical outcomes. Mutivariable logistic regression models evaluated the association between age and surgical outcome. Men with a history of hypospadias were excluded.

Results

Among 514 men having urethroplasty for which complete data was available, 85 (17%) were ≥70 years. Elderly men were more likely to have a history of radiation therapy (63% vs 5%, p<0.0001) and experience treatment failure (30% vs 12%, p=0.001) during follow up (mean 20 months). Accordingly, the 24-month stricture recurrence-free survival was 61% vs 78% (p=0.03). In men ≥70, the success rates of excision and primary anastomosis (EPA), substitution urethroplasty, and urethrostomy were 75%, 67%, and 80%. While stricture length, location, and prior endoscopic treatments were similar between cohorts, elderly men were more likely to have obliterative strictures (44% vs 28%), a shorter duration between diagnosis and treatment (median 46 vs 61 months), and undergo EPA (80% vs 66%). Following surgery there was no difference in overall <90 day complications (22% vs 18%); however elderly men were more likely to have a Clavien 3 or greater complication (13% vs 5%; p=0.005). Among treatment failures, men ≥70 failed earlier (8 vs 18 months; p=0.04) and were more likely to fail on subsequent intervention (55% vs 30%; p=0.05). On multivariable analysis, radiation (OR 2.91, 95% CI 1.36-6.24; p=0.006) and increasing age (OR 1.03, 95%CI 1.01-1.05; p=0.006) were independently associated with risk of treatment failure.

Conclusions

While advanced age is independently associated with urethroplasty failure, urethroplasty is a safe and effective treatment option for aging men with urethral stricture disease.

Funding

none