Risk Factors and Timing of Early Stricture Recurrence After Urethroplasty

Abstract

Objective: To compare recurrence after urethroplasty, identifying associated risk factors for early recurrence.

Materials and methods: Among 262 urethroplasties (2001-2010) with ≥6 months of follow-up, we identified 65 patients (24.8%) with recurrence (defined by obstruction in the area of repair on cystoscopy).

Results: Median stricture length was 4.5 cm (range 1-24 cm). Median follow-up was 85.2 (6.7-160.1) months, with median time to recurrence of 8.0 (0.5-88.0) months. Substitution urethroplasty was the most frequent repair (70.8%), followed by excision and primary anastomosis (23.1%). When graft was used, buccal was most common (66.0%), followed by abdominal wall skin (AWS) (24.5%). Twenty-one percent of recurrences presented within 3 months, 40.0% by 6 months, 55.4% by 1 year, whereas 9.2% recurred more than 5 years later. Recurrences ≤6 months were significantly longer strictures (median 5.5 cm vs 4.0 cm, P = .009). Strictures ≤4 cm, ≤3 cm, and ≤2 cm recurred at a median of 10.6, 18.2, and 30.3 months, respectively (P = .08). Most lichen sclerosis (LS)-related recurrences occurred within 6 months (62%). Patients recurring within 6 months were older, had history of LS, or more likely had AWS. Forty percent suffered from multiple recurrences at a median of 12 months and were associated with longer stricture, prior instrumentation, substitution urethroplasty, AWS, and LS.

Conclusion: Half of recurrences following urethroplasty present within one year, with most declaring within 6 months. Early recurrence is associated with older age, LS, AWS and longer strictures. The duration and intensity of surveillance protocols following urethroplasty should be individualized in order to account for these characteristics.