2017 Aug 18. pii: S0022-5347(17)77378-8. doi: 10.1016/j.juro.2017.08.081. [Epub ahead of print]

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.


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.