Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol

Katherine T. Anderson, Alex J. Vanni, Bradley A. Erickson, Jeremy B. Myers, Bryan Voelzke, Benjamin N. Breyer, Joshua A. Broghammer, Jill C. Buckley, Lee C. Zhao, Thomas G. Smith, Nejd F. Alsikafi, Keith F. Rourke, Sean P. Elliott

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

PURPOSE: A successful urethroplasty has been defined in different ways across studies. This variety in the literature makes it difficult to compare success rates and techniques across studies. We aim to evaluate the success of anterior urethroplasty based on different definitions of success in a single cohort.

MATERIALS AND METHODS: Data were collected from a multi-institutional, prospectively maintained database. We included men undergoing first-time, single-stage, anterior urethroplasty between 2006 and 2020. Exclusion criteria included lack of followup, hypospadias, extended meatotomy, perineal urethrostomy, posterior urethroplasty and staged repairs. We compared 5 different ways to define a "failed" urethroplasty: 1) stricture retreatment, 2) anatomical recurrence on cystoscopy, 3) peak flow rate <15 ml/second, 4) weak stream on questionnaire and 5) failure by any of these measures. Kaplan-Meier survival curves were generated for each of the definitions. We also compared outcomes by stricture length, location and etiology.

RESULTS: A total of 712 men met inclusion criteria, including completion of all types of followup. The 1- and 5-year estimated probabilities of success were "retreatment," 94% and 75%; "cystoscopy," 88% and 71%; "uroflow," 84% and 58%; "questionnaire," 67% and 37%; and "any failure," 57% and 23%. This pattern was inconsistent across stricture length, location and etiology.

CONCLUSIONS: The estimated probability of success after first-time, anterior urethroplasty is highly dependent on the way success is defined. The variability in definitions in the literature has limited our ability to compare urethroplasty outcomes across studies.

Original languageEnglish (US)
Pages (from-to)135-143
Number of pages9
JournalJournal of Urology
Volume208
Issue number1
DOIs
StatePublished - Jul 1 2022

Bibliographical note

Funding Information:
Conflict of Interest: Bradley Erickson: Boston Scientific: Investigator; Urotronic: Investigator. Keith Rourke: Red Leaf Medical: Speaker. Alex Vanni: Boston Scientific: Investigator. Jeremy Myers: Boston Scientific: Fellowship funds; Cooper Surgical: Consultant; Department of Defense: Investigator. Joshua Broghammer: Boston Scientific: Consultant. Sean Elliott: Boston Scientific: Consultant, Investigator; Urotronic: Investigator; Percuvision: Shareholder.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • follow-up studies
  • recurrence
  • retreatment
  • urethral stricture
  • Constriction, Pathologic/surgery
  • Urologic Surgical Procedures, Male/methods
  • Humans
  • Male
  • Treatment Outcome
  • Retrospective Studies
  • Urethra/surgery
  • Urethral Stricture/diagnosis

PubMed: MeSH publication types

  • Journal Article

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