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Predicting Outcomes After Urologic Surgery to Better Inform Patients and Providers

Nov. 24, 2020

Together with a team of medical students, I recently studied urethroplasty, the surgery commonly used to treat urethral stricture disease, to help urologists and patients better understand the factors that lead to successful surgeries.

Approximately 1% of men in the U.S. live with urethral stricture disease, a condition that occurs when scar tissue builds up in the urethra — the 15-centimer-long channel that carries urine out of the bladder — and leads to a decrease in the flow of urine. This can cause issues such as problems with urination, urinary tract infections, bladder stones and kidney damage.

The cause of a urethral scar is largely unknown. Some patients report a history of trauma to the urethra, and others report a history of urinary tract surgery that led to the scar tissue. Regardless of the cause, a urethral stricture can have a negative impact on quality of life.

To fix the scar tissue in the male urethra, urologists often perform a urethroplasty. I am a regional expert in this surgery and treat men with urethral stricture disease from across Texas, so to better understand the results of urethroplasties, my team studied factors associated with poor outcomes.

We reviewed the records of 110 men who had surgery for urethral stricture disease at Dell Seton Medical Center at The University of Texas from 2016 to 2020. Data analyzed included patient demographics; disease information including cause, symptoms, prior treatments and outcomes; and data on patients’ other health conditions. Data were analyzed as a whole as well as by type of urethroplasty performed.

Within the overall data, patients were more likely to experience a return of urethral stricture if they were obese, older than 55 or had complications after surgery. Patients were more likely to have a complication within 90 days of surgery if they had lichen sclerosus, a skin condition that causes scar tissue to form along the urethra. Within the buccal mucosal urethroplasty group, patients with scar tissue in the penis were less likely to experience stricture return after surgery.

Our team concluded that stricture return and complications after urethroplasty are not uncommon. Obesity and lichen sclerosus were associated with worse outcomes, while scar tissue in the penis was associated with better outcomes when a buccal graft was used.

While many researchers have previously studied factors associated with stricture return and complications after urethroplasty, prior studies only analyzed data as a whole. Our study is unique in that, after analyzing data as a whole, we analyzed data by type of surgery, providing a better understanding of factors associated with outcomes after surgery.

As a result, I believe these findings will allow myself and other urologists to better inform patients of their chance of having a successful urethroplasty.