Editorial Comment from Dr Horiguchi to Risk of urethral stricture recurrence increases over time after urethroplasty.

Abstract

Although the management of male urethral stricture disease has a wide variety of therapeutics, urethroplasty remains the gold standard that offers the lowest rates of stricture recurrence.1 However, there is no consensus about the follow-up strategies or the optimal intervals between and durations of follow up after urethroplasty. The present study describes the long-term follow up of 347 patients who underwent urethroplasty, evaluates the potential risks for stricture recurrence and concludes that the durations of follow up are an independent predictor of recurrence.2 The authors advocate that patients should be counseled appropriately on the potential risks of late stricture recurrence after urethroplasty, regardless of surgical procedures. Most stricture recurrences generally occur in the first year after urethroplasty and rise slightly in the subsequent 4 years of follow-up examinations, followed by relative stability.3-5 Lifelong follow up is necessary after substitution urethroplasty, because stricture recurrences can increase with time and occur even after 15 years as a result of the contracture of grafts or flaps.6 I agree with the authors that stricture recurrence increases with time in patients who undergo substitution urethroplasty. However, I was surprised by the results that show late recurrence occurring at an increased rate over time in patients who undergo anastomotic urethroplasty. It is evident from the literature that anastomotic urethroplasty is highly successful and has sustained durable results.4 I understand that scar formation at anastomotic sites stabilizes within 12 months after anastomotic urethroplasty, and that stricture recurrence after 12 months is rare. Santucci et al. reported a long-term (mean of 70 months postoperatively) outcome of anastomotic urethroplasty for 168 bulbar urethral strictures with a high recurrence-free rate (95%) and recurrences in just eight patients (the mean time to recurrence was 15 months).4 Notably, six out of eight patients (75%) experienced recurrences within 12 months, and only one experienced a late recurrence (at 80 months postoperatively).4 The recurrence rate according to Andrich et al. also appears to be stable at 5, 10 and 15 years after anastomotic urethroplasty.6 In accordance with the authors’ findings, I suppose these differences might be due to the number of patients who did not participate in follow-up examinations and could have experienced recurrences. Patients should be carefully monitored continually after urethroplasty irrespective of the type of procedure carried out, and surveillance protocols should be standardized. None declared.