Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions, Longer Strictures and More Complex Repairs

No AccessJournal of UrologyAdult Urology1 Feb 2018Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions, Longer Strictures and More Complex Repairs Boyd R. Viers, Travis J. Pagliara, Nabeel A. Shakir, Charles A. Rew, Lauren Folgosa-Cooley, Jeremy M. Scott, and Allen F. Morey Boyd R. ViersBoyd R. Viers , Travis J. PagliaraTravis J. Pagliara , Nabeel A. ShakirNabeel A. Shakir , Charles A. RewCharles A. Rew , Lauren Folgosa-CooleyLauren Folgosa-Cooley , Jeremy M. ScottJeremy M. Scott , and Allen F. MoreyAllen F. Morey View All Author Informationhttps://doi.org/10.1016/j.juro.2017.08.081AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prior to urethral reconstruction many patients with stricture undergo a variable period during which endoscopic treatments are performed for recurrent obstructive symptoms. We evaluated the association among urethroplasty delay, endoscopic treatments and subsequent reconstructive outcomes. Materials and Methods: We reviewed the records of men who underwent primary bulbar urethroplasty from 2007 to 2014. Those with prior urethroplasty, penile and/or membranous strictures and incomplete data were excluded from analysis. Men were stratified by a urethroplasty delay of less than 5, 5 to 10 or greater than 10 years from diagnosis. Results: A total of 278 primary bulbar urethroplasty cases with complete data were evaluated. Median time between stricture diagnosis and reconstruction was 5 years (IQR 2–10). Patients underwent an average ± SD of 0.9 ± 2.4 endoscopic procedures per year of delay. Relative to less than 5 and 5 to 10 years a delay of greater than 10 years was associated with more endoscopic treatments (median 1 vs 2 vs 5), repeat self-dilations (13% vs 14% vs 34%), strictures longer than 2 cm (40% vs 39% vs 56%) and complex reconstructive techniques (17% vs 17% vs 34%). An increasing number of endoscopic treatments was independently associated with strictures longer than 2 cm (OR 1.06, p = 0.003), which had worse 24-month stricture-free survival than shorter strictures (83% vs 96%, p = 0.0003). Each consecutive direct vision internal urethrotomy was independently associated with the risk of urethroplasty failure (HR 1.19, p = 0.02). Conclusions: Urethroplasty delay is common and often associated with symptomatic events managed by repeat urethral manipulations. Endoscopic treatments appear to lengthen strictures and increase the complexity of repair. 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Open J Urol2012; 2: 16. Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byElliott S, Coutinho K, Robertson K, D'Anna R, Chevli K, Carrier S, Aube-Peterkin M, Cantrill C, Ehlert M, Te A, Dann J, DeLong J, Brandes S, Hagedorn J, Levin R, Schlaifer A, DeSouza E, DiMarco D, Erickson B, Natale R, Husmann D, Morey A, Olsson C and Virasoro R (2021) One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-Coated Balloon for Anterior Urethral StricturesJournal of Urology, VOL. 207, NO. 4, (866-875), Online publication date: 1-Apr-2022.Buckley J (2017) Moving Beyond an Age-Old InterventionJournal of Urology, VOL. 199, NO. 2, (353-354), Online publication date: 1-Feb-2018.Smith J (2017) This Month in Adult UrologyJournal of Urology, VOL. 199, NO. 2, (315-317), Online publication date: 1-Feb-2018. Volume 199Issue 2February 2018Page: 515-521Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsendoscopycomplicationshealth carefailure to rescuereconstructive surgical proceduresurethral strictureMetricsAuthor Information Boyd R. Viers More articles by this author Travis J. Pagliara More articles by this author Nabeel A. Shakir More articles by this author Charles A. Rew More articles by this author Lauren Folgosa-Cooley More articles by this author Jeremy M. Scott More articles by this author Allen F. Morey Financial interest and/or other relationship with Boston Scientific and Coloplast. More articles by this author Expand All Advertisement PDF downloadLoading ...