Urethral Injury Treatment Challenge. Comparison of Surgical Treatments for Acquired or Iatrogenic Urethral Stenosis and Predictive Values for Failure of Each Surgical Method

Abstract

Introduction: Minimal invasive endo-urologic interventions and prostate surgeries performed through the urethral route are the most commonly used surgeries in the urology field at present. One of the unwanted complications weeks after some of these surgeries is urethral stenosis.Aim: In this study, we aimed to review our treatment methods for patients with urethral stricture occurring after urologic interventions retrospectively to evaluate our success rates and data predicting recurrence and to determine the most feasible method.Materials and methods: From 2008 to 2017, we evaluated retrospectively 234, 85, and 51 patients with urethral stenosis due to iatrogenic causes treated with direct visual internal urethrotomy (DVIU), anastomotic excision urethroplasty, and buccal graft urethro-plasty, respectively. Postoperative Qmax above 15 mL/s and >17 CH cystoscope easily passing the urethra was accepted as success for patients. Group variables were compared using ANOVA. Multivariate logistic regression analysis was performed to determine variables with predictive values. Predictive values significant in regression analysis (p<0.005) were evaluated with ROC analysis.Results: Patients were followed up for mean 48 (16-56) months, 48 (23-60) months, and 50 (32-65) months after DVIU, anastomotic and graft urethroplasty, respectively, and success was obtained for 75 (32.1%), 71 (83.5%) and 42 patients (82.4%). Multivariate logistic regression analysis found age, DM, BMI and stenosis length were independent predictive factors for DVIU success, while stenosis length was the independent predictive factor for excision anastomosis and buccal graft urethroplasty success. Cut-off values were determined as 56.5 years of age, 30.2 kg/m2 BMI and 1.85 mm stenosis length for DVIU patients, while 2.15 mm and 5.9 mm stenosis lengths,  respectively, were determined for excision anastomosis and buccal graft urethroplasty with ROC analysis.Conclusions: DVIU is a failed method for urethral stenosis in the long term. In contrast, resection / anastomosis and graft urethro-plasty are very successful methods.

Keywords

• anastomosis
• buccal graft
• stenosis
• TUR-prostat