Early Post-Operative Events After Urethroplasty in Obese Patients: A Multi-Institutional Retrospective Series

J Patrick Mershon; Janine Bennett; Matthew Murtha; Taylor A Goodstein; Tasha Posid; Niels Johnsen; E Charles Osterberg; Andrew J Cohen; Victor Heh; Greg P Murphy; Nima Baradaran

doi:10.1016/j.urology.2024.05.003

Early Post-Operative Events After Urethroplasty in Obese Patients: A Multi-Institutional Retrospective Series

Urology. 2024 May 14:S0090-4295(24)00355-8. doi: 10.1016/j.urology.2024.05.003. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: John.Mershon@osumc.edu.
² Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH.
³ Department of Urology, Vanderbilt University, Nashville, TN.
⁴ Department of Urology, University of Texas at Austin Dell Medical School, Austin, TX.
⁵ Department of Urology, Johns Hopkins University, Baltimore, MD.
⁶ Department of Urology, Washington University of St. Louis, St. Louis, MO.
⁷ Department of Urology, Eastern Virginia Medical School, Norfolk, VA.

PMID: 38754790
DOI: 10.1016/j.urology.2024.05.003

Abstract

Objective: To compare early urethroplasty outcomes in non-obese, obese and morbidly obese patients undergoing urethroplasty for urethral stricture disease. The impact of obesity on outcomes is poorly understood but will be increasingly important as obesity continues to rise.

Methods: Patients underwent urethroplasty at one of the 5 institutions between January 2016 and December 2020. Obese (BMI 30-39.9, n = 72) and morbidly obese (BMI >40, n = 49) patients were compared to normal weight (BMI <25, n = 29) and overweight (BMI 25-29.9, n = 51) patients. Demographics, comorbidities, and stricture characteristics were collected. Outcomes including complications, recurrence, and secondary interventions were compared using univariate and multivariate analysis.

Results: Two hundred and one patients (Mean BMI 34.1, Range 18.4-65.2) with mean age 52.2 years (SD=17.2) were analyzed. Median follow-up time was 3.71 months. Obese patients were younger (P = .008), had more anterior (P <.001), iatrogenic and LS-associated strictures (P = .036). Sixty-day complication rate was 26.3% with no differences between cohorts (P = .788). Around 9.5% of patients had extravasation at catheter removal, 18.9% reported stricture recurrence, and 7.4% required additional interventions. Obese patients had greater estimated blood loss (P = .001) and length of stay (P = .001). On multivariate analysis, smoking associated with contrast leak (OR 7.176, 95% CI 1.13-45.5) but not recurrence or need for intervention (P = .155, .927).

Conclusion: Obese patients in our cohort had more anterior, iatrogenic, and LS-related strictures. However, obesity is not associated with complications, contrast leak, secondary interventions, or recurrence. Obese had higher blood loss and length of stay. Urethroplasty is safe and effective in obese patients.