PD60-02 DELAY OF URETHROPLASTY IS ASSICIATED WITH LONGER STRICTURES AND MORE COMPLICATED REPAIRS

Abstract

Listen

Translate article

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) IV1 Apr 2017PD60-02 DELAY OF URETHROPLASTY IS ASSICIATED WITH LONGER STRICTURES AND MORE COMPLICATED REPAIRS Boyd Viers, Travis Pagliara, Charles Rew, Lauren Folgosa-Cooley, Christine Shiang, Jeremy Scott, and Allen Morey Boyd ViersBoyd Viers More articles by this author , Travis PagliaraTravis Pagliara More articles by this author , Charles RewCharles Rew More articles by this author , Lauren Folgosa-CooleyLauren Folgosa-Cooley More articles by this author , Christine ShiangChristine Shiang More articles by this author , Jeremy ScottJeremy Scott More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2748AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bulbar urethral strictures ≤ 2 cm are generally amenable to excision and primary anastomosis (EPA) and associated with excellent outcomes. We hypothesized that men having repeated endoscopic treatments of urethral strictures developed increased spongiofibrosis, thus leading to longer strictures requiring more complex repairs. The objective of this study was to analyze clinical characteristics of patients having bulbar strictures > 2 cm requiring complex repairs in comparison to those with shorter strictures. METHODS We retrospectively reviewed our urethroplasty database of over 1200 patients from 2007-2016. We identified 365 patients undergoing first-time urethroplasty for bulbar urethral stricture disease with complete data available and at least 2 years of follow-up. Penile strictures and posterior urethral stenosis were excluded. Pretreatment characteristics were evaluated to identify associations with intraoperative bulbar urethral stricture length. A cutpoint of 2 cm was used to identify preoperative characteristics associated with shorter strictures more amenable to EPA versus those requiring substitution urethroplasty. RESULTS Of the 365 (64%) primary bulbar urethral strictures treated, 160 (44%) were > 2 cm in length. These longer bulbar urethral strictures > 2 cm (LBUS) were associated with a greater delay between stricture diagnosis and urethroplasty (mean 117 vs 81 months, p=0.01) and greater total number of prior endoscopic interventions (mean 8 vs 3, p=0.005) compared to shorter strictures. Accordingly, LBUS were less likely to undergo EPA relative to those with strictures ≤ 2 cm (64% vs 99%, p<0.0001). When stratified by time from initial diagnosis to definitive urethroplasty (≤ 5 years, 5-10 years, and >10 years), a clear incremental increase was identified in procedures performed (p<0.0001) and stricture length (p=0.004) (Fig 1). Men with strictures >2 cm were more likely to experience urethroplasty failure (18% vs 9%, p=0.01). Specifically, each additional endoscopic stricture incision was associated with a 1.25-fold increased risk of urethroplasty failure (p=0.007). On multivariable analysis, only increasing number of endoscopic interventions (OR 1.02, 95%CI 1.00-1.05; p=0.04) was independently associated with bulbar urethral stricture length >2 cm. CONCLUSIONS Delay between initial stricture diagnosis and definitive reconstruction is associated with increasing numbers of endoscopic treatments, lengthening of strictures, and greater risk of urethroplasty failure. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1183 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Boyd Viers More articles by this author Travis Pagliara More articles by this author Charles Rew More articles by this author Lauren Folgosa-Cooley More articles by this author Christine Shiang More articles by this author Jeremy Scott More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...