PURPOSE To identify independent risk factors for urethroplasty failure in a prospective dataset. METHODS Since 2008, data of all male patients undergoing urethroplasty at Ghent University Hospital have been prospectively recorded and maintained. This analysis excluded: posterior strictures, strictures of the perineostomy, urethral malignancy-related strictures, age < 18 years and follow-up < 1 year. Postoperatively, a voiding cysto-urethrography (VCUG) was performed after 2 weeks and in absence of significant contrast extravasation, the transurethral catheter was removed. Patients were followed after 3 m, 12 m and annually thereafter. Failure was defined as stricture recurrence requiring additional urethral intervention(s). Uni- and multivariate Cox regression analyses were performed on the entire patient cohort and for one-stage urethroplasty (OSU) at specific locations. RESULTS In total, 474 patients were included. Median follow-up was 62 m (IQR 35-91). Significant extravasation was present in 6.9%. Bulbar stricture location was identified as independent protective factor for urethroplasty failure (HR 0.44; p = 0.046) and significant extravasation at first VCUG was identified as independent risk factor for urethroplasty failure (HR 2.86; p = 0.005). Cox regression analyses for OSU at specific locations could not identify other risk factors. All but one (89%) of the failures preceded by significant extravasation at first VCUG occurred within 2 years of follow-up whereas 44% of the failures with no or insignificant extravasation at first VCUG occurred after 2 years of follow-up (p = 0.03). CONCLUSIONS Bulbar stricture location is an independent protective factor for urethroplasty failure. Significant extravasation at first urethrography is an independent risk factor for urethroplasty failure and is associated with earlier stricture recurrence than other failed cases.

中文翻译：

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尿道前路成形术后失败的独立危险因素：前瞻性数据的多元分析。

目的确定前瞻性数据集中尿道成形术失败的独立危险因素。方法自2008年以来，对根特大学医院所有接受尿道成形术的男性患者的数据进行前瞻性记录和维护。该分析不包括：后部狭窄，会阴切开术狭窄，与尿道恶性肿瘤相关的狭窄，年龄<18岁和随访<1年。术后2周后行膀胱膀胱尿道造影（VCUG），并且在没有明显造影剂外渗的情况下，取下经尿道导管。分别在3 m，12 m之后和之后每年随访患者。失败定义为狭窄复发，需要额外的尿道干预。对整个患者队列和特定位置的一期尿道成形术（OSU）进行单变量和多变量Cox回归分析。结果总共纳入474例患者。中位随访时间为62 m（IQR 35-91）。显着外渗占6.9％。球囊狭窄位置被确定为尿道成形术失败的独立保护因素（HR 0.44； p = 0.046），首次VCUG的大量外渗被确定为尿道成形术失败的独立危险因素（HR 2.86； p = 0.005）。在特定位置进行OSU的Cox回归分析无法确定其他风险因素。在首次VCUG手术中，只有一个（89％）的失败发生在严重的外渗之后，发生在随访的2年内；而在第一次VCUG手术中，没有或没有明显的外渗的失败中，有44％发生在随访2年后（p = 0.03）。结论球囊狭窄部位是尿道成形术失败的独立保护因素。初次尿道造影显着外渗是尿道成形术失败的独立危险因素，并且比其他失败病例更早发生狭窄复发。