Sunday June 30, 2019 from 07:30 to 09:00
The evolution of urethral stricture and urethroplasty over 15 years: A single-centre, single-surgeon 1319 urethroplasty analysis
R. Christopher Doiron1, Keith F. Rourke1.
1Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
Introduction: The management of urethral strictures has evolved dramatically over the last 15 years. We aimed to analyze trends in patient presentation and reconstructive practice in all patients undergoing urethroplasty at a single centre over 15 years.
Methods: Patients undergoing urethroplasty by single surgeon (KFR) from August 2003 to May 2018 were included in the analysis. Patient demographics, clinical presentation, and surgical procedure and outcomes data were collected in a prospectively maintained database. A retrospective analysis categorized patients into three, five-year cohorts based on date of surgery, and trends over time were analyzed.
Results: A total of 1319 urethroplasties were completed over the study period. During the first five years (T1), 299 urethroplasties were performed, while 431 and 589 were performed in T2 and T3, respectively. Mean overall patient age was 46.8 years and this increased significantly over time (p<0.001). Most patients presented with an idiopathic cause of their stricture (n=516, 39%) and this did not change over time. Trauma was the second most common etiology overall (n=262, 20%), but decreased significantly over time (p<0.001). Radiation-induced strictures significantly increased over time (n=9, 3% ([T1], n=22, 5% [T2], n=51, 9% ([T3]; p=0.001), as did iatrogenic strictures. Mean stricture length was 4.4 cm and this decreased over time (4.7 cm [T1], 4.8 cm [T2], 4.0 cm [T3]; p<0.001). Most patients presented with a previously failed endoscopic treatment alone (n=861, 65%), while 249 patients (19%) had additionally undergone a prior open reconstruction. Overall, patients had a mean of 3.2 prior endoscopic procedures; this decreased over time (3.4 [T1]), 3.9 [T2], and 2.5 [T3]; p<0.001). Overall, single-stage urethroplasty with buccal mucosa was the most common technique performed (n=656, 50%) and increased in prevalence over time (p=0.009), while both flap and staged techniques decreased over time (p=0.008, p=0.004, respectively). The remaining techniques did not vary over time. Finally, the overall success rate was 90% (n=1106). This appeared to improve significantly with time (n=248, 87% [T1], n=359, 90% [T2], n=499, 93% [T3]; p=0.001].
Conclusions: The surgical treatment of urethral stricture has evolved over the last 15 years with an increase in patient age, increase in radiation and iatrogenic strictures, decrease in stricture length, and a reduction in the number of endoscopic procedures performed prior to referral. Increased use of single-stage urethroplasty using buccal mucosa was observed, which may have contributed to an increase in urethroplasty success over the same time period.