Urethroscopic Findings Following Urethroplasty Predict the Need for Secondary Intervention in Long-Term: A Multi-Institutional Study from Trauma and Urologic Reconstructive Network of Surgeons.
Post-operative surveillance urethroscopy has been shown to be an effective tool to predict re-operation within one year after urethroplasty. We aimed to evaluate early surveillance urethroscopy findings and long-term outcomes among urethroplasty patients in order to define the value of surveillance urethroscopy to predict failure.
We evaluated 304 patients with at least four years of follow-up after urethroplasty performed at ten institutions across the United States and Canada. All patients were surveilled using a flexible 17Fr cystoscope and were categorized into three groups: a. normal lumen; b. large-caliber stricture (≥17Fr) defined as the ability of the cystoscope to easily pass the narrowing; c. small-caliber stricture (<17Fr) that the cystoscope could not be passed. Failure was stricture recurrence requiring a secondary intervention.
The median follow-up time was 64.4 months (range 55.3-80.6) and the time to initial surveillance urethroscopy was 3.7 months (range 3.1-4.8) following urethroplasty. Secondary interventions were performed in 29 of 194 (15%) with normal lumens, 11 of 60 (18.3%) with ≥17Fr strictures, and 32 of 50 (64%) with <17Fr strictures (p <0.001). The 1-, 3-, and 9-year cumulative probability of intervention was 0.01, 0.06, and 0.23 for normal, 0.05, 0.17, and 0.18 for ≥17Fr, and 0.32, 0.50, and 0.73 for <17Fr lumen groups, respectively. Patient reported outcome measures performed poorly to differentiate the three groups.
Early cystoscopic visualization of scar recurrence that narrows the lumen to <17Fr following urethroplasty is a significant long-term predictor for patients who will eventually undergo a secondary intervention.
Amend, Gregory M., Behnam Nabavizadeh, Nizar Hakam, Bryan B. Voelzke, Thomas G. Smith, Bradley A. Erickson, Sean P. Elliott, et al. “Urethroscopic Findings Following Urethroplasty Predict the Need for Secondary Intervention in Long-Term: A Multi-Institutional Study from Trauma and Urologic Reconstructive Network of Surgeons.” The Journal of Urology, December 2, 2021, 101097JU0000000000002353. https://doi.org/10.1097/ju.0000000000002353.