MP78-07 THE PREVALENCE OF CONCOMITANT SQUAMOUS METAPLASIA IN BULBAR URETHRAL STRICTURES AND ITS ASSOCIATION WITH RECONSTRUCTIVE DELAY AND URETHRAL REST BY SUPRAPUBIC URINARY DIVERSION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP78-07 THE PREVALENCE OF CONCOMITANT SQUAMOUS METAPLASIA IN BULBAR URETHRAL STRICTURES AND ITS ASSOCIATION WITH RECONSTRUCTIVE DELAY AND URETHRAL REST BY SUPRAPUBIC URINARY DIVERSION Yusuke Hirano, Akio Horiguchi, Masayuki Shinchi, Kenichiro Ojima, Keiichi Ito, Ryuichi Azuma, and Kosuke Miyai Yusuke HiranoYusuke Hirano More articles by this author , Akio HoriguchiAkio Horiguchi More articles by this author , Masayuki ShinchiMasayuki Shinchi More articles by this author , Kenichiro OjimaKenichiro Ojima More articles by this author , Keiichi ItoKeiichi Ito More articles by this author , Ryuichi AzumaRyuichi Azuma More articles by this author , and Kosuke MiyaiKosuke Miyai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Squamous metaplasia (SM) of a normal urethral epithelium is considered to be the initial pathological change associated with a urethral stricture. SM proximal to a stricture is a severe problem that may affect the choice of urethroplasty technique and surgical outcome. A histological analysis was conducted to evaluate the prevalence of SM in bulbar urethral strictures and the association with delayed reconstruction and urethral rest. METHODS: We reviewed the records of 169 male patients with bulbar urethral strictures who had undergone excision and primary anastomosis (EPA) between 2010 and 2020 by a single surgeon (AH). Those with prior urethroplasty and incomplete data were excluded from analysis. The proximal edges of formalin-fixed, paraffin-embedded urethral sections were sliced axially, and ImageJ measured the ratio of the urethral lumen in which SM was present on HE-stained slides by an experienced pathologist (MK). Reconstructive delay was calculated as the time between the initial stricture diagnosis and EPA. Urethral rest was accomplished by suprapubic tube placement and cessation of voiding at least three months before EPA. The success of EPA was defined as the absence of need for additional treatment. RESULTS: SM was present in 88 patients (52.1%), and the median ratio of SM in the urethral lumen was 13.5%. The median reconstructive delay in patients with SM (40 months) was significantly longer than that in patients without SM (9 months, p<0.0001). Patients with SM were significantly more likely to have had no urethral rest (p<0.0001) and undergo repeat transurethral treatments such as urethrotomy and dilation before EPA (p=0.0002). Multivariate logistic regression analysis showed that a longer reconstructive delay (for every month: odds ratio (OR) 1.01, 95% confidence interval (CI) 1.00–1.02, p=0.004) and absence of urethral rest (OR 3.82, 95% CI 1.59–9.20, p=0.002) were significant predictors of concomitant SM. There was no significant difference in the success rates between patients with SM (82 of 88, 93.1%) and those without SM (79 of 81, 97.5%, p=0.18). CONCLUSIONS: Persistent chronic high-pressure voiding due to reconstructive delay and absence of urethral rest are responsible for concomitant SM. Source of Funding: Nothing © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yusuke Hirano More articles by this author Akio Horiguchi More articles by this author Masayuki Shinchi More articles by this author Kenichiro Ojima More articles by this author Keiichi Ito More articles by this author Ryuichi Azuma More articles by this author Kosuke Miyai More articles by this author Expand All Advertisement PDF downloadLoading ...