[Urethral strictures treated with excision and primary anastomosis: Impact of etiology on care pathways and management]

Abstract

Background and objectives: Excision and primary anastomosis is a common treatment of the short urethral posterior strictures. Strictures can be associated to pelvic bone fractures, endourological procedure (iatrogenic) or idiopathic. Whether outcomes are different with respect to etiology is still under reported. Herein, we aimed to explore the impact of etiology on care pathway and management of patients treated with excision and primary anastomosis for urethral strictures.

Patients and methods: Between January 2004 and December 2015, 97 patients were referred and treated with excision and primary anastomosis for a short urethral stricture. Data were extracted from a single institutional registry and retrospectively analyzed. Patients were sorted into 3 groups with respect to the etiology: pelvic bone fracture (n=23), iatrogenic (n=24) and idiopathic (n=50). Preoperative patient's and stricture characteristics as well as postoperative outcomes of the three groups were compared using Student or Chi² tests as appropriate. Specifically, recurrence rate and time to first recurrence was analyzed according to a Cox proportional hazard model.

Results: Patients with strictures caused by pelvic bone fracture were younger (P<0.001), more likely to have a suprapubic catheter (P=0.007), and no attempted procedures before the referral (P<0.001). Strictures length and maximum flowmetry were similar in all groups. Postoperatively, 90-d complications and flowmetry were similar in both groups. After a mean follow-up of 25±24 (range: 1-102) months, 27 (27.8 %) patients recurred. According to our model, etiology did not seem to impact overall recurrence rate. However, when the subgroup of patients with recurrence were analyzed, strictures associated with pelvic bone seemed to recur faster than the 2 remaining groups.

Conclusion: With some limitations of due to the population size and the retrospective design of the analysis, etiology impacted care pathway in terms of referral and initial management of patients treated with excision and primary anastomosis for a short urethral posterior stricture. However, recurrence rate and mid-term outcomes seem less impacted.

Level of evidence: 4.

Keywords: Etiology; Sténose de l’urètre; Traitement; Treatment; Urethral strictures; Uretroplasty; Urétroplastie; Étiologie.