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Independent risk factors for failure after anterior urethroplasty: a multivariate analysis on prospective data

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Abstract

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.

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Abbreviations

DVIU:

Direct vision internal urethrotomy

FFS:

Failure-free survival

HR:

Hazard ratio

IQR:

Interquartile range

OSU:

One-stage urethroplasty

RUG:

Retrograde urethrography

USS-PROM:

Urethral stricture surgery patient-reported outcome measures

UTI:

Urinary tract infection

VCUG:

Voiding cysto-urethrography

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Authors and Affiliations

  1. Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium

    Wesley Verla, Marjan Waterloos, Anne-Françoise Spinoit, Willem Oosterlinck & Nicolaas Lumen

Authors
  1. Wesley Verla
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  2. Marjan Waterloos
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  3. Anne-Françoise Spinoit
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  4. Willem Oosterlinck
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  5. Nicolaas Lumen
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Contributions

VW: Project development, data collection and management, data analysis, manuscript writing and editing. WM: Data collection and management, manuscript editing. SAF: Project development, manuscript editing. OW: Data collection and management, manuscript editing. LN: Project development, data collection and management, manuscript editing.

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Correspondence to Wesley Verla.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Verla, W., Waterloos, M., Spinoit, AF. et al. Independent risk factors for failure after anterior urethroplasty: a multivariate analysis on prospective data. World J Urol 38, 3251–3259 (2020). https://doi.org/10.1007/s00345-020-03123-0

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  • DOI: https://doi.org/10.1007/s00345-020-03123-0

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