Urology. 2017 Jul 26. pii: S0090-4295(17)30763-X. doi: 10.1016/j.urology.2017.07.022. [Epub ahead of print]

Characteristics of Idiopathic Urethral Strictures: a Link to Remote Perineal Trauma?

Viers BR1, Pagliara TJ1, Rew CA1, Cooley LF1, Shiang CY1, Scott JM1, Morey AF2.

To characterize the physical features and reconstructive outcomes of a series of idiopathic urethral stricture (IUS) cases in an effort to elucidate the nature of this common, yet poorly understood entity.

We retrospectively reviewed our urethroplasty database to identify men undergoing initial urethral reconstruction from 2007-2014 at one of three hospitals (N=514). Patients were stratified by stricture etiology including IUS, acute trauma, iatrogenic, hypospadias, balanitis xerotica obliterans, and radiation. IUS who had a known history of subacute or repetitive blunt force to perineum (horseback riding, avid cycling, motocross, etc.) were sub-classified as SRPT.

Among 466 men undergoing initial reconstruction with available data, 215 (46%) were IUS. Median delay between IUS diagnosis and urethroplasty was 5.2 years during which time men underwent a median 2 endoscopic treatments. A total of 51 (24%) IUS recalled a distinct history of SRPT. While men with SRPT were slightly younger (median 43 vs 48 years; p=0.01), they were remarkably similar in terms of urethral stricture length (2 vs 2 cm; p=0.15), location (bulbar 96% vs 89%; p=0.41), and treatment success (92% vs 88%; p=0.61). Bulbar (-)SRPT and (+)SRPT IUS had similar clinical and morphometric features as those with known acute bulbar trauma with excellent 24-month stricture recurrence-free survival rates (93% vs 92% vs 97%; p=0.19).

IUS have clinical features suggesting that many may be related to unrecognized or repetitive perineal trauma. While treatment tends to be delayed, IUS have excellent urethroplasty success because most are short bulbar strictures amenable to anastomotic urethroplasty.