MP35-09 LOWER URINARY TRACT SYMPTOM NON-RESPONSE (″LUTS FAILURE″) AFTER URETHROPLASTY

Abstract

INTRODUCTION AND OBJECTIVE: Urethroplasty is a highly effective treatment for urethral stricture. However, some patients fail to experience significant improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence of ″LUTS failure″ after urethroplasty and examine associated factors. METHODS: Patients undergoing urethroplasty over a 6-year period (January 2012 – December 2018) were offered enrollment in a study examining urinary function after urethroplasty. Urinary function and urinary quality of life (UQOL) were assessed pre-operatively and at 6 months postoperatively using the international prostate symptoms score (IPSS). ″LUTS failure″ was defined as less than 3-point improvement in IPSS. Stricture recurrence was defined as the inability to pass a 16Fr flexible cystoscope. Patients not completing pre- and post-operative IPSS questionnaires and patients with stricture recurrence were excluded from analysis. Descriptive statistics were used to summarize findings while multivariate binary logistic regression was used to determine the association between clinical factors and LUTS failure. RESULTS: Of the 828 patients undergoing urethroplasty over this period, 387 patients completed IPSS scores pre- and post-operatively and of these 372 (96.1%) were stricture free on cystoscopy at 6 months. Mean patient age was 49.5 years, mean stricture length was 4.3cm and 84.4% of patients failed prior endoscopic treatment. Stricture location, etiology and urethroplasty technique were typical of that found in most industrialized nations. As expected, mean IPSS (19.0 vs. 5.4; p<0.0001) and median UQOL (5 vs. 1; p<0.0001) were improved post-urethroplasty. Despite being stricture free on cystoscopy, 13.7% of patients did not experience improvement in IPSS (″LUTS failure″) and 10.2% did not report improvement in UQOL. On multivariate binary logistic regression, increasing patient age (OR 1.04, 95% CI 1.01-1.06, p=0.006), lichen sclerosus (OR 7.6, 95% CI 1.1-51.0, p=0.04) and hypospadias strictures (OR 8.3, 95% CI 1.3-54.0, p=0.03) were associated with "LUTS failure" while stricture location (p=0.46), length (p=0.07), previous urethroplasty (p=0.86), prior endoscopic treatment (p=0.50), type of urethroplasty (p=0.17) and other etiologies were not. Increasing patient age was the sole factor associated with a lack of improvement in UQOL (OR 1.03, 95% CI 1.01-1.06, p=0.02). CONCLUSIONS: While the majority of patients experience improvement in lower urinary tract function after urethroplasty, 13.7% experience ″LUTS failure″ despite being stricture-free on cystoscopy and 10.2% report no improvement in UQOL. Both occurrences are independently associated with increasing patient age and may be related to concurrent benign prostatic hyperplasia or alternately detrusor dysfunction related to longstanding bladder outlet obstruction. Source of Funding: Northern Alberta Urology Foundation