What is an acceptable re-stricture rate after urethroplasty?

Summary 

Objective

To assess a single surgeon's re-stricture rate after urethroplasty in an unselected group of patients compared with a highly selected group of complex patients and so define a re-stricture rate that can be used for counselling patients preoperatively.

Patients

In the 3-year period 2004–2007 the authors between them performed 554 urethral reconstructions and the senior author performed the 123 most complex cases. In the same 3-year period the senior author also performed 146 consecutive unselected urethral reconstructions in a separate unit alone. The results of these two sets of patients were compared.

Results

In the combined unit the senior surgeon's overall re-stricture rate with complex cases was 11%. None occurred in the bulbar urethroplasty group and the re-stricture rate was the same in the primary cases and the revision cases.

In the unselected group of patients the re-stricture rate was 4–11% and varied according to the location and complexity of the stricture.

Conclusions

Case mix influences the results of surgery and can double the re-stricture rate from about 5% to about 10%. Bulbar urethroplasty has the lowest re-stricture rate. Penile urethral surgery for strictures of increasing length carries an increasingly high re-stricture rate. The re-stricture rate after transperineal repair of pelvic fracture urethral injuries is 5–10% again according to complexity. The surgery of posterior urethral strictures is an altogether different technical exercise which should be considered separately.

Keywords: Urethral stricture, Urethroplasty, Results