Introduction: We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty.Methods: We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr oncystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression.Results: In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5 cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence.Conclusion: Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.

We evaluated preoperative risk factors associated with stricture recurrence in a large, homogenous series of bulbar urethroplasties. We analyzed the records of 596 patients who underwent isolated bulbar urethroplasty at a single center from August 2003 to June 2015. Urethroplasty failure was defined as stricture less than 16Fr identified on cystoscopy with a minimum of 12 months of followup. The potential risk factors examined were patient age, stricture etiology, stricture length, diabetes, smoking, obesity, Charlson comorbidity index, previous endoscopic treatment, previous urethroplasty and type of urethroplasty. Univariate and multivariable Cox regression analysis was used to evaluate potential risk factors and associations. Average stricture length was 3.9 cm and mean patient age was 44.4 years. Overall urethral patency was 93.3% and mean followup was 65.4 months (range 12 to 149). Previous endoscopic treatment had failed in 88.1% of patients while previous urethroplasty had failed in 10.7%. On multivariate analysis increased stricture length (HR 1.2, 95% CI 1.1-1.3, p = 0.01), increased patient comorbidity (HR 2.4, 95% CI 1.1-5.3, p = 0.03), obesity (HR 2.9, 95% CI 1.3-6.5, p = 0.01) and infectious strictures (HR 3.7, 95% CI 1.3-10.6, p = 0.02) were associated with stricture recurrence. Previous urethroplasty, the number of failed endoscopic procedures, type of urethroplasty and individual comorbidities such as diabetes, smoking and patient age did not affect the recurrent stricture rate. Although bulbar urethroplasty has a good stricture-free rate, patients with increased stricture length, increased overall comorbidity, obesity and strictures of infectious etiology are at higher risk for failure. These patients at risk should be counseled accordingly and perhaps be followed more closely after urethroplasty.

We describe patency outcomes and predictors of success for the endoscopic treatment of vesicourethral stenosis after radical prostatectomy. A retrospective review identified 142 patients who underwent endoscopic treatment for vesicourethral stenosis after radical prostatectomy during a 10-year period. Clinical parameters examined were treatment modality, prior endoscopic treatment, age, concurrent radiotherapy, body mass index 35 kg/m(2) or greater, diabetes and smoking. The primary outcome measure was absence of stenosis (less than 16Fr) on followup cystoscopy. Treatment modalities were divided into 5 groups of holmium laser incision, cold knife incision, electrocautery incision, dilation or UroLume® stent. Descriptive statistics as well as univariate and multivariate logistic regression were performed. A total of 142 patients required 292 endoscopic treatments for a mean of 2.1 treatments per patient. The success rate of a single endoscopic treatment was 44.2%. However, 91% of the patients were ultimately treated successfully with endoscopic measures with a mean followup of 9.7 months. On multivariate analysis treatment modality (OR 0.65, 95% CI 0.52-0.80, p <0.001), prior failed treatment (OR 0.86, 95% CI 0.74-0.99, p=0.04) and smoking (OR 0.55, 95% CI 0.34-0.97, p=0.04) were associated with failure, while age (p=0.85), diabetes (p=0.25), radiotherapy (p=0.68) and body mass index 35 kg/m(2) or greater (p=0.92) were not. Compared to holmium laser incision all modalities except UroLume were associated with treatment failure. Most patients with vesicourethral stenosis after radical prostatectomy are treated successfully with endoscopic modalities but often require multiple procedures. Unlike anterior urethral strictures, in this specific scenario the use of repeat endoscopic treatments appears justified. Holmium laser incision may be more successful compared to other endoscopic modalities.