Abstract
ABSTRACTObjective To examine the impact of obesity on perioperative outcomes and urethral stricture recurrence after anterior urethroplasty.Material and Methods We reviewed our prospectively maintained single-surgeon database to identify men with anterior urethral strictures who had undergone anastomotic or augmentation urethroplasty between October 2012 and March 2018. In all, 210 patients were included for primary analysis of perioperative outcomes, while 193 patients with at least 12 months follow-up were included for secondary analysis of stricture recurrence. Patients grouped by BMI were compared using univariate and multivariate analyses for perioperative outcomes and log rank testing for recurrence-free survival.Results Overall, 41% (n=86) of patients were obese and 58.6% (n=123) had bulbar urethral strictures. Obese patients had significantly longer urethral strictures (mean=6.7cm±4.7) than nonobese patients (p <0.001). Though urethroplasty in obese patients was associated with increased estimated blood loss (EBL) relative to normal BMI patients on both univariate (p=0.003) and multivariate (p <0.001) analyses, there was no difference in operative time, length of stay, or complication rate between BMI groups. At a mean follow-up interval of 36.7 months, 15% (n=29) of patients had stricture recurrence, yet recurrence-free survival was not significantly different between groups (log rank p=0.299). Dorsal augmentation urethroplasty resulted in significantly fewer recurrences in obese patients compared to nonobese patients (p=0.036).Conclusion Despite the association with increased urethral stricture length and EBL, obesity is not predictive of adverse perioperative outcomes or stricture recurrence. Obese patients should be offered urethral reconstruction, but patient selection and preoperative counseling remain imperative.
Highlights
Urethral stricture disease can be burdensome for patients, both medically and socially
Obesity has been associated with higher complication rates and urethroplasty failure [6], but it is not clear whether all perioperative measures are adversely affected in obese patients
There were no significant differences in stricture location between groups, etiologies varied with obese patients being more likely to have LS or an iatrogenic stricture than nonobese patients and less likely to have a history of genital trauma (p=0.036)
Summary
Urethral stricture disease can be burdensome for patients, both medically and socially. Urethroplasty is the gold standard for treatment and has success rates as high as 85-90% [1] These repairs are technically challenging and, risk of recurrence aside, are subject to complications including bleeding, infection, deep vein thrombosis, urethrocutaneous fistula, and erectile dysfunction. There has been uncertainty regarding the impact of obesity on surgical outcomes in patients with urethral stricture disease. Obesity has been associated with higher complication rates and urethroplasty failure [6], but it is not clear whether all perioperative measures are adversely affected in obese patients. Based on existing data regarding obesity and perioperative complications, we hypothesized that obese patients have worse outcomes across a number of perioperative indexes including estimated blood loss, operative time, length of stay, and risk of complications. We hypothesized that obese patients are prone to higher rate of urethral stricture recurrence
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