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JU INSIGHT Affirming Long-Term Outcomes After Contemporary Urethroplasty
By: Carlos Ignacio Calvo, MD, University of Alberta, Edmonton, Canada, Pontificia Universidad Católica de Chile, Santiago; Kai Fender, BSc, University of Alberta, Edmonton, Canada; Nathan Hoy, MD, FRCSC, University of Alberta, Edmonton, Canada; Keith Rourke, BSc, MD, FRCSC, University of Alberta, Edmonton, Canada | Posted on: 18 Mar 2024
Calvo CI, Fender K, Hoy N, Rourke K. Affirming long-term outcomes after contemporary urethroplasty: the adverse impact of increasing stricture length, lichen sclerosus, radiation, and infectious strictures. J Urol. 2024;211(3):455-464.
Study Need and Importance
Urethral stricture is a relatively common condition that causes a wide spectrum of symptoms, signs, and complications with an associated reduction in patient-reported quality of life. Urethral reconstruction is broadly considered the most effective treatment and is often recommended for patients with recurrent urethral stricture. But there is a paucity of reported long-term outcomes after modern urethroplasty. This study evaluated the long-term success of contemporary urethroplasty and identified factors associated with stricture recurrence in this context.
What We Found
A total of 733 patients were identified with a minimum of 100 months of follow-up after urethroplasty. At a median follow-up of 12.3 years, 89 recurrences were observed (12%). The cumulative incidence of stricture recurrence was 6%, 10%, and 12% after 1, 5, and 10 years, respectively (Figure). From a patient-reported perspective, 89% of patients reported being satisfied with surgery. On multivariable analyses, increasing stricture length (HR 1.1, 95% CI 1.05-1.15; P < .001) and etiology (P < .001), in particular lichen sclerosus (HR 4.46, 95% CI 2.25-9.53), radiation (HR 4.25, 95% CI 1.65-10.9), and infectious strictures (HR 5.27, 95% CI 2.03-13.7), were independently associated with recurrence.
Limitations
One of the main limitations of our study is the retrospective design despite being a diligently maintained robust cohort of patients undergoing urethroplasty with long-term follow-up. Another limitation is the lack of a validated questionnaire to assess some patient-reported outcomes. Lastly, to avoid overfit of our statistical model only a select number of predictors could be examined in the multivariable analysis.
Interpretation for Patient Care
As a unique observational cohort study, this study affirms that urethroplasty provides high rates of long-term success and patient-reported satisfaction. This objective and patient-reported information will enrich preoperative patient counseling, in particular for those patients with longer strictures, lichen sclerosus, radiation, and infectious etiologies that have a higher risk of stricture recurrence in the long-term.
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