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World J Urol. 2019 Feb 2. doi: 10.1007/s00345-019-02653-6. [Epub ahead of print]

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

Author information

1
Department of Urology, Ohio State University, Columbus, OH, USA.
2
Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
3
Division of Urology, University of Utah, Salt Lake City, UT, USA.
4
Department of Urology, University of Washington, Seattle, WA, USA.
5
Department of Urology, Baylor College of Medicine, Houston, TX, USA.
6
Department of Urology, University of Iowa, Iowa City, IA, USA.
7
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
8
Uropartners, Gurnee, IL, USA.
9
Department of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA.
10
Department of Urology, University of California San Diego, San Diego, CA, USA.
11
New York University School of Medicine, New York, NY, USA.
12
Department of Urology, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA. benjamin.breyer@ucsf.edu.

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:

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

PMID:
30712091
DOI:
10.1007/s00345-019-02653-6

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