Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results
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We investigated the success rate of different surgical techniques for bulbar stricture repair.
Retrospective study of patients with bulbar urethral strictures treated using different techniques. The primary outcome of the study was to evaluate the overall results of treatment (success vs. failure); the secondary outcome was to evaluate the outcome according to any surgical technique. Cysto-urethrography was performed 1 month following surgery. Patients underwent clinical evaluation, uroflowmetry and residual urine measurement every 6 months for 2 years after surgery and later once on year. When patient showed obstructive symptoms, Qmax < 12 ml/s, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as failures. A bivariable and multivariable statistical analysis was performed.
Overall, 1242 patients were included in the study with mean age 40 years (range 12–84). Median stricture length was 4 cm (range 1–8). The median follow-up was 103 months (range 12–362). Over 1242 patients, 916 (73.8%) were success and 326 (26.2%) failures. Fourteen different surgical techniques showed a success rate ranging from 87.5 to 14.3%. The multivariable analysis showed that stricture length was an independent predictor factors for failure: p < 0.0001 CI 1146–1509. End–end anastomosis and oral mucosa graft urethroplasty are independent predictor factor of success after internal urethrotomy failure.
Our results showed that treatment of bulbar urethral stricture is satisfactory on 73.8% of patients, but with a wide range of success rate (from 14.3 to 87.5%) using different techniques. Oral mucosa is greatly superior to the skin as substitute material.
KeywordsUrethra Urethroplasty Urethrotomy Surgical technique Oral mucosa Skin graft Long-term results
Authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. GB: project development, manuscript writing. FM: project development. SB: data analysis. SS: data analysis. CL: data analysis. DB and VB: data analysis and statistical analysis. ML: project development, manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.