Urethroplasty practice and surveillance patterns: a survey of reconstructive urologists

Abstract

Objective: To survey urologic reconstruction experts to determine practice and surveillance patterns used after urethroplasty.

Methods: We conducted an international survey of the members of the Society of Genitourinary Reconstructive Surgeons between July 23 and October 13, 2010 through email. Participants were surveyed regarding the nomenclature used to define strictures, urethroplasty practice patterns, follow-up practice patterns, and methods used to screen for stricture recurrence.

Results: The response rate was 48.9% (n = 90). Urethroplasty failure was commonly defined as the need for a secondary urethral procedure (60.0%), significant narrowing on imaging (14.4%), urethral narrowing preventing passage of 16F cystoscope (12.2%) or poor uroflow, or American Urological Association Symptom Score (7.8%). Only one-third of responders followed up their patients >3 years after surgery. To screen for stricture recurrence, 85% used uroflowmetry, 56% used postvoid residual, 19% used flexible cystoscopy, and 17% used retrograde urethrography. Nearly half (48%) of the surgeons did not use validated instruments to evaluate the quality of life after urethroplasty. For those who used validated questionnaires, the ones most often used were the American Urological Association Symptom Score (41%) and Sexual Health Inventory for Men (19%).

Conclusion: There is no consensus regarding follow-up practices after urethroplasty. Most experts define urethroplasty failure as "need for a secondary procedure," do not follow-up patients for a long-term, and do not use validated questionnaires. A standardized definition for stricture recurrence and a standardized follow-up protocol are desperately needed to allow for effective comparison of results between studies.