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Patterns of stricture recurrence post-urethroplasty stratified by stricture aetiology, segment and length in adult males.

B. Huang¹, M. Mo¹, D. Devang¹

¹Queensland Health, Urology, Toowoomba, Australia

Introduction:

Urethral stricture characteristics, such as aetiology and length, are reported to predict risk of stricture recurrence post urethroplasty. Stricture length >5cm, as well as lichen sclerosus, radiation, infectious and iatrogenic stricture aetiologies have been associated with increased rates of post-urethroplasty stricture recurrence. Few studies investigated associations between stricture segment and recurrence. This study aimed to report associations between stricture aetiology, segment and length with recurrence post-urethroplasty.

Material and methods:

A single surgeon, multi-institution, prospective cohort study was performed on all male patients undergoing urethroplasty for diverse stricture aetiology from January 2017 – October 2024. Stricture aetiology was classified into traumatic, idiopathic, iatrogenic, infectious, post-hypospadias repair and lichen sclerosus. Stricture length was grouped into ≤2cm, >2–≤7cm and >7cm. Stricture segments were divided into 7 categories from bulbar to penile and meatus. Procedure, age, diabetic and smoking history, prior endoscopic interventions and previous urethroplasties were recorded. Recurrence was determined by patient dissatisfaction requiring secondary management. Descriptive statistics were used to present baseline characteristics. Multiple logistic regression models were used to delineate association between stricture characteristics and recurrence.

Results:

In total, 188 patients (with 216 presentations) were included. Mean (SD) age was 56 (17) years. Success rate, defined as patient satisfaction requiring no further intervention, was 89.6%. Mean follow-up was 21 months (max 60 months). Most common aetiologies were idiopathic (32%), iatrogenic (20%) and traumatic (13%). Stricture length of >2 – ≤7cm was most common (47%), followed by ≤2cm (44%) and >7cm (9%). Most affected urethral segments were mid-bulbar (37%), penile involving fossa/meatus (18%), penile alone (16%) and mid-distal bulbar (14%). Logistic regression revealed no differences in patient characteristics and prior treatments (p>0.05). Radiation strictures had significantly increased odds of recurrence (p=0.037), with an odds ratio (95% CI) of 17.33 (1.19 – 253.19). Compared to mid-bulbar strictures, penile strictures with navicular fossa and meatus involvement were found to have significantly increased risk of recurrence (p=0.026), with an odds ratio (95% CI) of 2.90 (1.14–7.37). Odds ratios (95% CI) of recurrence in patients with stricture length >2 – ≤7cm and >7cm relative to ≤2cm were 1.19 (0.58–2.44) and 1.24 (0.37–4.20) respectively. These were not significant (p>0.05).