Perioperative Outcomes and Trends of Surgical Correction of Male Urethral Strictures: Results from the GRAND Study

Abstract

Background: While various techniques for the surgical correction of urethral strictures exist, data on their trends and perioperative outcomes are limited. Methods: Data from the German Nationwide Inpatient Data (GRAND) registry (2005-2023) were used to estimate the trends, baseline characteristics, and perioperative outcomes of the surgical techniques for urethral stricture correction. Results: A total of 500,937 patients underwent surgery. Internal urethrotomy was the most frequently performed procedure (n = 413,095, 82%), followed by urethral dilatation (n = 39,619, 8%), meatoplasty (n = 30,774, 6%), urethroplasty with buccal mucosa (n = 12,351, 2%), urethral excision with primary anastomosis (n = 3428, 0.7%), urethroplasty with preputial skin (n = 1585, 0.3%), and drug-coated balloon dilatation (n = 85, <0.1%). In recent years, internal urethrotomy declined; urethroplasty was relatively stable, and drug-coated balloon dilatation emerged as a promising treatment modality. Internal urethrotomy and urethral dilatation were predominantly performed in older patients (median age of 71 years), while urethroplasty was performed in younger (56 years). Preputial skin urethroplasty had a shorter hospital stay compared to buccal mucosa (-0.4 days, p = 0.02), with no significant differences in transfusion or sepsis rates. Conclusions: Internal urethrotomy remains the most frequently used technique despite declining utilization. Preputial skin urethroplasty presents similar perioperative outcomes compared to buccal mucosa urethroplasty.

Keywords: internal urethrotomy; perioperative outcomes; surgical trends; urethral strictures; urethroplasty.

Figure 1

The annual trends of major techniques for the surgical correction of urethral strictures. Note that the Y-axis scale differs in (A,B).