Analysis And Study Of Related Factors Of Recurrent Stricture After Urethroplasty

Objectives: To analysis and study the related factors of patients with sticture recurrence after urethroplasty and explore the mechanism and preventive methods.Method:Patients managed with urethroplasty were retrospectively studied from Jan.2017 to Nov.2018 in our center,clinical data was collected through medical record system and phone consultation.Inclusion criteria were male patient,surgeries were performed by the same group of doctors and follow-up time was less than 6months.Exclusion criteria were patients with incomplete medical history,patients with urethra-rectal fistula or multiple strictures.The definition of stricture recurrence were urinary symptoms after removal of catheter,and endoscopic or radiographic evidence of obstruction in the area of repair.Potentially related factors were analyzed,cases with recurrent stricture were consulted the therapeutic method and efficacy.Results: In total 313 patients were included in this study,cases were divided into penile urethra group and bulbar-posterior urethra group according to the clinical features and management methods.105 cases with penile urethral stricture,average age were 40.2 years(15～77years),causes included 38 cases with iatrogenic injury,15 with hypospadias,7 with inflammatory strictures and 6 with LS and 32 were idiopathic or no definite cause,stricture length 5.43 ± 2.27 cm.Average following time was18.3 ± 9.6months,29 cases encountered with stricture recurrence.Multivariate analysis indicated the wound infection(HR=7.212,P=0.007)and stricture length(HR=1.175,P=0.045)were independent risk factors for recurrence.For recurrent patients,22 cases were managed with surgical interventions,7 were untreated or waiting for surgery.Among treated patients,13 cases had a satisfied urine,9 encountered recurrence and 3 were complicated by urethral skin fistula.208 cases with bulbar-posterior urethral strictures were involved,average age 42.2years(5～78years),including posterior urethral stricture 182 cases and bulbar urethral stricture 26 cases.The causes were trauma 189 cases,iatrogenic 12 cases,inflammation 2cases and unknown 5 cases,stricture length was 3.18 ± 0.66 cm.Average following time was17.8 ± 7.2months,26 cases encountered with recurrence.Multivariate analysis indicated that stricture length(HR=5.998,P<0.001),history of urethroplasty≥2 times(HR=3.090,P=0.049)and 3 months smoking before surgery(HR=4.562,P=0.007)were independent risk factors,and preoperative cystostomy(HR=0.231,P=0.035)was a protective factor.For stricture recurrence patients,21 cases had surgical managements,5 were untreated or waiting for surgery.Among treated patients,14 cases had a satisfied urine and 7 encountered recurrence.Conclusion: Most of stricture recurrences occurred in 6 months after surgery.Wound infection and stricture length were independent risk factors for penile urethral stricture recurrence.For patients with bulbar-posterior urethral stricture,the stricture length,urethroplasty≥2 times and 3 months smoking before surgery were independent risk factors for recurrence,and cystostomy was a protective factor.Redo-urethroplasty was effective for proper recurrence,urethral diversion can improve the urinary symptom for complex long segment pendulous recurrences.