PD60-04 PREDICTIVE FACTORS OF SUCCESS IN ADULT PATIENTS TREATED FOR URETHRAL STRICTURE AFTER PRIMARY HYPOSPADIAS REPAIR FAILURE: A MULTIVARIABLE ANALYSIS OF A SINGLE-SURGEON SERIES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) IV1 Apr 2017PD60-04 PREDICTIVE FACTORS OF SUCCESS IN ADULT PATIENTS TREATED FOR URETHRAL STRICTURE AFTER PRIMARY HYPOSPADIAS REPAIR FAILURE: A MULTIVARIABLE ANALYSIS OF A SINGLE-SURGEON SERIES Guido Barbagli, Nicola Fossati, Alessandro Larcher, Francesco Montorsi, Salvatore Sansalone, Denis Butnaru, and Massimo Lazzeri Guido BarbagliGuido Barbagli More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Salvatore SansaloneSalvatore Sansalone More articles by this author , Denis ButnaruDenis Butnaru More articles by this author , and Massimo LazzeriMassimo Lazzeri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2750AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The repair of urethral strictures after hypospadias repair still represent a challenging problem. Although the number of surgeries for the correction of primary hypospadias may represent a risk factor for surgical failure, no evidence for this currently exists in the current literature. Therefore, we investigated the predictive factors of success in adult patients treated for urethral stricture after primary hypospadias repair failure. METHODS The study was an observational, retrospective, descriptive study of adults with urethral strictures following hypospadias surgery. We included only patients with complete clinical data regarding the type of primary hypospadias, the number of operations needed for repair and the surgeon who performed the repair. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcomes consisted of the relationships between the site of hypospadias, the site of the stricture and patient demotivation, defined as patient refusal of further treatments. Statistical analyses were performed using Stata (StataCorp LP, College Station, TX, USA) version 12.0. Tests were two-sided with a significance level set at p<0.05. RESULTS Overall, 408 patients were included in the study. The most frequent type of primary hypospadias was penile (56%), whereas the most frequent site of secondary stricture was penile (49%). A concordance between the site of primary hypospadias and the site of the secondary stricture was observed. A Kaplan Meier analysis revealed that two-stage techniques were significantly associated with lower treatment failure-free survival compared to one-stage techniques (p=0.001). At multivariable analysis, the number of previous operations needed for initial hypospadias repair was not associated with the risk of treatment failure (hazard ratio 0.95; 95% Confidence Interval: 0.88 - 1.03; p=0.2). Conversely, length of stenosis, with a cut-off of 3 cm (HR 1.42; CI 1.09 - 1.74; p=0.003), and presence of lichen sclerosus (HR 1.92; CI 1.01 - 3.65; p=0.047) were associated with an increased risk of treatment failure. Age (HR 1.03; CI 1.01 - 1.05; p=0.003), diabetes (HR 6.68; CI 1.38 - 32.3; p=0.018), penile hypospadias (HR HR 0.40; CI 0.24 - 0.68; p<0.001) and presence of lichen sclerosus (HR 2.51; CI 1.24 - 5.09; p=0.011) were associated with increased risk of patient demotivation for further surgeries. CONCLUSIONS Stricture length, but not the number of previous operations needed for primary hypospadias repair, was associated with the risk of failure. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1184 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Guido Barbagli More articles by this author Nicola Fossati More articles by this author Alessandro Larcher More articles by this author Francesco Montorsi More articles by this author Salvatore Sansalone More articles by this author Denis Butnaru More articles by this author Massimo Lazzeri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...