Histopathologic and clinical comparison of recurrent and non-recurrent urethral stricture disease treated by reconstructive surgery

Iryna V Samarska; Hasan Dani; Trinity J Bivalacqua; Arthur L Burnett; Andres Matoso

doi:10.21037/tau-21-477

Histopathologic and clinical comparison of recurrent and non-recurrent urethral stricture disease treated by reconstructive surgery

Transl Androl Urol. 2021 Oct;10(10):3714-3722. doi: 10.21037/tau-21-477.

Authors

Iryna V Samarska^{1

2}, Hasan Dani³, Trinity J Bivalacqua^{3

4}, Arthur L Burnett^{3

4}, Andres Matoso^{2

3

4}

Affiliations

¹ Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands.
² Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
³ Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
⁴ Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Abstract

Background: Urethral stricture is a relatively frequent problem often requiring multiple surgical interventions. The objective of this study was to compare the clinicopathologic features of urethral resections from patients who underwent open end-to-end anastomotic urethroplasty and later recurred compared to those who did not.

Methods: A retrospective review of the pathology files identified 36 consecutive patients who underwent urethroplasty. The histopathological analysis included evaluation of the inflammatory infiltrate based on the predominant (>50%) cell type: lymphocyte-rich, neutrophil-rich, plasma cell-rich, and mixed; length and thickness of the fibrous plaque; and the cellularity of the fibrous plaque: cellular (>40 stroma nuclei/HPF) or paucicellular (<40 stroma nuclei/high power field).

Results: Ten (28%) patients recurred, and 26 (72%) did not. There was no significant difference between recurrent and non-recurrent cases in age, race, comorbidities, location of the stricture, and etiology. All patients with recurrent strictures showed dense paucicellular fibrotic plaques (10/10; 100%), while this was seen in 14/26 (53.8%) non-recurrent cases (P=0.01). Only one patient with cellular fibrosis showed recurrence during follow-up. The log-rank test shows that time to recurrence is significantly shorter in patients with paucicellular fibrosis compared to those with cellular fibrosis (P=0.036). The inflammation consisted of a mixed population of CD3(+) T-lymphocytes, CD20(+) B-lymphocytes, and CD68(+) histiocytes, and there was no difference in the composition of the inflammation between groups. All cases with plasma cell-rich infiltrate showed normal IgG4:IgG.

Conclusions: Our study supports reporting cellularity of the fibrous plaque as a potential predictor of outcome in patients undergoing reconstructive urethroplasty. Patients with paucicellular fibrosis are at increased risk of recurrence.

Keywords: Urethral stricture; urethral obstruction; urethroplasty.