Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions, Longer Strictures, and More Complex Repairs.
Prior to urethral reconstruction, many stricture patients undergo a variable period during which endoscopic treatments are employed for recurrent obstructive symptoms. We evaluate the association between urethroplasty delay, endoscopic treatments, and subsequent reconstructive outcomes.
MATERIALS AND METHODS:
We reviewed men undergoing primary bulbar urethroplasty from 2007-2014. Prior urethroplasty, penile and/or membranous strictures, and cases with incomplete data were excluded. Men were stratified by urethroplasty delay of <5, 5-10, and >10 years from diagnosis.
A total of 278 primary bulbar urethroplasty cases with complete data were evaluated. Median time between stricture diagnosis and reconstruction was 5 years (IQR 2-10). Patients underwent an average 0.9 (± 2.4) endoscopic procedures per year of delay. Relative to <5 and 5-10 years, delay >10 years was associated with more endoscopic treatments (median 1 vs 2 vs 5), repetitive self-dilations (13% vs 14% vs 34%), strictures >2 cm (40% vs 39% vs 56%), and complex reconstructive techniques (17% vs 17% vs 34%). Increasing number of endoscopic treatments (OR 1.06; p=0.003) was independently associated with strictures >2 cm, which had worse 24-month stricture-free survival compared to shorter strictures (83% vs 96%; p=0.0003). Each consecutive DVIU was independently associated with risk of urethroplasty failure (HR 1.19; p=0.02).
Urethroplasty delay is common and often associated with symptomatic events managed by repetitive urethralmanipulations. Endoscopic treatments appear to lengthen strictures and increase complexity of repair.