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

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

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)857-864
Number of pages8
JournalJournal of Urology
Volume207
Issue number4
DOIs
StatePublished - Apr 1 2022

Bibliographical note

Funding Information:
Supported by a grant from Boston Scientific fellowship.

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

Keywords

  • cystoscopy
  • reconstructive surgical procedures
  • recurrence
  • urethra
  • urethral stricture
  • Recurrence
  • Reoperation
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Urethra/surgery
  • Reconstructive Surgical Procedures/adverse effects
  • Urologic Surgical Procedures, Male/adverse effects
  • Aged, 80 and over
  • Aged
  • Endoscopy
  • Postoperative Complications/diagnosis
  • Urethral Stricture/diagnosis

PubMed: MeSH publication types

  • Multicenter Study
  • Journal Article

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