Urethroscopic Findings following Urethroplasty Predict the Need for Secondary Intervention in the Long Term: A Multi-Institutional Study from Trauma and Urologic Reconstructive Network of Surgeons. Academic Article uri icon

Overview

abstract

  • PURPOSE: Postoperative surveillance urethroscopy has been shown to be an effective tool to predict reoperation within 1 year after urethroplasty. We aimed to evaluate early surveillance urethroscopy findings and long-term outcomes among urethroplasty patients in order to define the value of surveillance urethroscopy to predict failure. MATERIALS AND METHODS: We evaluated 304 patients with at least 4 years of followup after urethroplasty performed at 10 institutions across the United States and Canada. All patients were surveilled using a flexible 17Fr cystoscope and were categorized into 3 groups: 1) normal lumen, 2) large-caliber stricture (≥17Fr) defined as the ability of the cystoscope to easily pass the narrowing and 3) small-caliber stricture (<17Fr) that the cystoscope could not be passed. Failure was stricture recurrence requiring a secondary intervention. RESULTS: The median followup time was 64.4 months (range 55.3-80.6) and the time to initial surveillance urethroscopy was 3.7 months (range 3.1-4.8) following urethroplasty. Secondary interventions were performed in 29 of 194 (15%) with normal lumens, 11 of 60 (18.3%) with ≥17Fr strictures and 32 of 50 (64%) with <17Fr strictures (p <0.001). The 1-, 3- and 9-year cumulative probability of intervention was 0.01, 0.06 and 0.23 for normal, 0.05, 0.17 and 0.18 for ≥17Fr, and 0.32, 0.50 and 0.73 for <17Fr lumen groups, respectively. Patient-reported outcome measures performed poorly to differentiate the 3 groups. CONCLUSIONS: Early cystoscopic visualization of scar recurrence that narrows the lumen to <17Fr following urethroplasty is a significant long-term predictor for patients who will eventually undergo a secondary intervention.

authors

  • Amend, Gregory M
  • Nabavizadeh, Behnam
  • Hakam, Nizar
  • Voelzke, Bryan B
  • Smith, Thomas G
  • Erickson, Bradley A
  • Elliott, Sean P
  • Alsikafi, Nejd F
  • Vanni, Alex J
  • Buckley, Jill C
  • Zhao, Lee C
  • Myers, Jeremy B
  • Peterson, Andrew C
  • Rourke, Keith F
  • Broghammer, Joshua A
  • Breyer, Benjamin N

publication date

  • December 2, 2021

Research

keywords

  • Endoscopy
  • Plastic Surgery Procedures
  • Urethra
  • Urethral Stricture
  • Urologic Surgical Procedures, Male

Identity

Scopus Document Identifier

  • 85126072658

Digital Object Identifier (DOI)

  • 10.1097/JU.0000000000002353

PubMed ID

  • 34854754

Additional Document Info

volume

  • 207

issue

  • 4