Citation
Anderson KT, Vanni AJ, Erickson BA, Myers JB, Voelzke B, Breyer BN, Broghammer JA, Buckley JC, Zhao LC, Smith TG 3rd, Alsikafi NF, Rourke KF, Elliott SP. Defining Success after Anterior Urethroplasty: An Argument for a Universal Definition and Surveillance Protocol. J Urol. 2022 Mar 3:101097JU0000000000002501. doi: 10.1097/JU.0000000000002501. Epub ahead of print. PMID: 35239415.
Abstract
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. 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. 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. 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.
Key Points
- Published in The Journal of urology in 2022.
- Indexed in PubMed as PMID 35239415.
- Mapped to Urethral Stricture & Urethroplasty, Outcomes, Methods & Education.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This article contributes to the urethral stricture and urethroplasty literature, with emphasis on staging, reconstruction, definitions of success, and long-term functional outcomes.