092 Age ≤40 Is An Independent Predictor Of Anastomotic Urethroplasty And Successful Repair Of Bulbar Urethral Strictures

Abstract

Our impression is that younger men tend to have straightforward bulbar urethral strictures compared to middle-aged and older patients, with more robust tissue characteristics and fewer attempts at endoscopic manipulation We sought to compare stricture characteristics, repair type, and treatment success in younger versus older patient groups. A single surgeon retrospective review of patients undergoing bulbar urethroplasty between 2008 and 2017 was performed, age-stratified into ≤40 and >40 yo. Penile strictures and those with history of hypospadias were excluded. Patient characteristics, surgical approach and outcomes were collected by review of a large, tertiary urethroplasty database. Success was defined by functional emptying and lack of repeat surgical intervention. Parameters associated with failure were included in multivariate logistic regression models. A total of 750 patients with bulbar strictures were identified, with 204 patients (27.2%) ≤40 years old, and 546 patients (72.8%) >40 years old. Mean stricture length was similar between the younger and older groups (2.4 vs. 2.7 cm, respectively, p=0.10). Percentage of patients managed with excision and primary anastomosis (EPA) declined with age (89% in ≤40 group, 77% in >40, p=0.002). Younger men had undergone significantly fewer endoscopic stricture treatments than the older group (1.8 vs. 5.4, p<0.001). Traumatic etiology was more commonly identified in the younger cohort (48% vs. 24%, p<0.001). The ≤40 group less frequently presented with diabetes (2% vs. 22%, p<0.0001), coronary artery disease (0.5% vs. 20%, p<0.0001), and erectile dysfunction (11% vs. 27%, p<0.0001) compared to older men. Over a median follow-up of 52.4 months, success rates were higher in the ≤40 cohort (96.9%) than the >40 cohort (85.8%, p=0.001). On multivariate logistic regression analysis, independent predictors of urethroplasty success include younger age (OR 0.51, CI 0.28-0.95, p=0.02), utilization of EPA (OR 2.49, CI 1.27-4.90, p=0.01), and lack of pelvic radiation (OR 2.40, CI 1.09-5.28, p=0.03).