462 - Urinary symptom non-response (“LUTS failure”) after urethroplasty: Incidence and associations

Abstract

OBJECTIVE An ill-defined proportion of patients undergoing urethroplasty fail to experience improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence, associations, and causes of "LUTS failure" after urethroplasty. METHODS Patients undergoing urethroplasty over a 6-year period were offered enrollment in a prospective study examining urinary function after urethroplasty. Patients were assessed pre-operatively and 6-months postoperatively using the international prostate symptom score (IPSS) and cystoscopy. "LUTS failure" was defined ≤3-point improvement in IPSS, despite an anatomically successful urethroplasty. Multivariable logistic regression was utilized to evaluate the association patient factors with "LUTS Failure". RESULTS Of 365 patients meeting inclusion criteria, mean postoperative IPSS (20.3 vs. 5.4; p< 0.0001) and median urinary quality of life (UQOL) (5 vs. 1; p <0.0001) were significantly improved. Despite being stricture-free, 7.7% of patients reported "LUTS failure" and 10.1% reported UQOL non-response. On multivariable logistic regression, increasing age (OR1.04, 95% CI 1.01-1.06, p=0.006) and hypospadias (OR18.2, 95% CI 2.1-156.0, p=0.008) were associated with "LUTS failure" while stricture location (p=0.76), length (p=0.14), previous urethroplasty (p=0.96), failed endoscopic treatment (p=0.17), type of urethroplasty (p=0.93) and other etiologies were not. Qualitatively, the most likely causes of "LUTS failure" were detrusor underactivity (39.3%), overactivity (21.4%), pelvic floor dysfunction (21.4%) or BPH (14.3%). Only increasing age was associated with UQOL non-response (OR1.03, 95% CI 1.01-1.07, p=0.02). CONCLUSION While many patients experience improved voiding function after urethroplasty, 7.7% experience "LUTS failure" and 10.1% report UQOL non-response. Both occurrences are independently associated with increasing patient age and most commonly related to detrusor underactivity.