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Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS)

  • Nima Baradaran
  • Kirkpatrick B. Fergus
  • Rachel A. Moses
  • Darshan P. Patel
  • Thomas W. Gaither
  • Bryan B. Voelzke
  • Thomas G. SmithIII
  • Bradley A. Erickson
  • Sean P. Elliott
  • Nejd F. Alsikafi
  • Alex J. Vanni
  • Jill Buckley
  • Lee C. Zhao
  • Jeremy B. Myers
  • Benjamin N. BreyerEmail author
Original Article

Abstract

Purpose

To assess the functional Queryoutcome of patients with cystoscopic recurrence of stricture post-urethroplasty and to evaluate the role of cystoscopy as initial screening tool to predict future failure.

Methods

Cases with cystoscopy data after anterior urethroplasty in a multi-institutional database were retrospectively studied. Based on cystoscopic evaluation, performed within 3-months post-urethroplasty, patients were categorized as small-caliber (SC) stricture recurrence: stricture unable to be passed by standard cystoscope, large-caliber (LC) stricture accommodating a cystoscope, and no recurrence. We assessed the cumulative probability of intervention and the quality of life scores in association with cystoscopic recurrence 1-year post-urethroplasty. Patients with history of hypospadias, perineal urethrostomy, urethral fistula, and meatal pathology were excluded.

Results

From a total of 2630 men in our cohort, 1054 patients met the inclusion criteria: normal (n = 740), LC recurrence (n = 178), and SC recurrence (n = 136) based on the first cystoscopic evaluation performed at median 111 days postoperatively. Median follow-up was 350 days (IQR 121–617) after urethroplasty. Cystoscopic recurrence was significantly associated with secondary interventions (2.7%, 6.2%, 33.8% in normal, LC, and SC groups, respectively). Quality of life variables were not statistically significantly different among the three study groups.

Conclusions

Many patients with cystoscopic recurrence do not need an intervention after initial urethroplasty. Despite good negative predictive value, cystoscopy alone may be a poor screening test for stricture recurrence defined by patient symptoms and need for secondary interventions.

Keywords

Urethra Lower urinary tract symptoms Urethral stricture Cystoscopy Self report Treatment outcome 

Notes

Author contributions

Protocol/project development: NB, KBF, TWG, BNB. Data collection or management: NB, KBF, RAM, DPP, BV, TSIII, BE, SE, NA, AV, JB, LZ, JM, BNB. Data analysis: KBF, TWG. Manuscript writing/editing: NB, KBF, RAM, DPP, TWG, BV, TSIII, BE, SE, NA, AV, JB, LZ, JM, BNB.

Funding

None.

Compliance with ethical standards

Conflict of interest

The Authors report no conflict of interest pertinent to this study.

Ethical statement

Research has been approved by institutional IRB of all the involved institutions. All participants have either consented to retrospective data collection or waived need for consent per institutional policy.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nima Baradaran
    • 1
  • Kirkpatrick B. Fergus
    • 2
  • Rachel A. Moses
    • 3
  • Darshan P. Patel
    • 3
  • Thomas W. Gaither
    • 2
  • Bryan B. Voelzke
    • 4
  • Thomas G. SmithIII
    • 5
  • Bradley A. Erickson
    • 6
  • Sean P. Elliott
    • 7
  • Nejd F. Alsikafi
    • 8
  • Alex J. Vanni
    • 9
  • Jill Buckley
    • 10
  • Lee C. Zhao
    • 11
  • Jeremy B. Myers
    • 3
  • Benjamin N. Breyer
    • 2
    Email author
  1. 1.Department of UrologyOhio State UniversityColumbusUSA
  2. 2.Department of Urology, Zuckerberg San Francisco General Hospital and Trauma CenterUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Division of UrologyUniversity of UtahSalt Lake CityUSA
  4. 4.Department of UrologyUniversity of WashingtonSeattleUSA
  5. 5.Department of UrologyBaylor College of MedicineHoustonUSA
  6. 6.Department of UrologyUniversity of IowaIowa CityUSA
  7. 7.Department of UrologyUniversity of MinnesotaMinneapolisUSA
  8. 8.UropartnersGurneeUSA
  9. 9.Department of UrologyLahey Hospital and Medical CenterBurlingtonUSA
  10. 10.Department of UrologyUniversity of California San DiegoSan DiegoUSA
  11. 11.New York University School of MedicineNew YorkUSA

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