Abstract
Objectives To explore the differences between primary and redo urethroplasty and to directly compare according stricture-free survival (SFS). Materials and Methods. Data of all male patients who underwent urethroplasty at Ghent University Hospital were collected between 2000 and 2018. Exclusion criteria for this analysis were age <18 years and follow-up <1 year. Two patient groups were created for further comparison: the primary urethroplasty (PU) group (no previous urethroplasty) and redo urethroplasty (RU) group (≥1 previous urethroplasty), irrespective of prior endoscopic treatments. A comparison between groups was performed using the Mann–Whitney U test and Fisher's Exact test. SFS was calculated using Kaplan–Meier statistics. A functional definition of failure, being the need for further urethral manipulation, was used. Uni- and multivariate Cox regression analyses were performed on the entire patient cohort. Results 805 patients were included. Median (IQR) follow-up of the PU (n = 556) and RU (n = 556) and RU (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (p=0.1). The RU group involved more penile strictures (Conclusions Several differences between primary and redo urethroplasties exist. Redo urethroplasty entails a distinct patient population to treat and is, in general, associated with lower stricture-free survival than primary urethroplasty, although more homogeneous series are required to corroborate these results. Prior urethroplasty and diabetes are independent risk factors for urethroplasty failure.
Highlights
Urethroplasty is considered the standard treatment option for urethral stricture disease (USD) as it offers substantially higher long-term success rates than direct vision internal urethrotomy (DVIU) or urethral dilatation [1, 2]
Two patient groups were created for further comparison: the primary urethroplasty (PU) group and redo urethroplasty (RU) group (≥1 previous urethroplasty), irrespective of prior endoscopic treatments
Scarce data are available on the management of recurrent USD and only little is known about the differences between primary and redo urethroplasty
Summary
Urethroplasty is considered the standard treatment option for urethral stricture disease (USD) as it offers substantially higher long-term success rates than direct vision internal urethrotomy (DVIU) or urethral dilatation [1, 2]. Several risk factors for failure after urethroplasty have been described, among which prior therapy for USD [3,4,5,6]. Against this background, the question whether redo urethroplasty provides the same satisfying outcome as primary urethroplasty should be considered. Scarce data are available on the management of recurrent USD and only little is known about the differences between primary and redo urethroplasty. A redo urethroplasty is often more challenging as recurrent urethral strictures usually have denser and more extensive scar tissue
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