Presentation Authors: Christopher King*, Keith Rourke, Edmonton, Canada
Introduction: While urethral stricture can diminish patient-reported quality of life, a substantial proportion of patients will also experience complications directly related to urethral stricture. The objective of this study is to determine the frequency of complications related to urethral stricture and identify clinical factors associated with them.
Methods: 1851 patients with urethral stricture presenting to a single urologist from 2005 to 2016 were retrospectively reviewed. Clinical variables examined were complications directly related to urethral stricture at the time of stricture presentation, presenting signs/symptoms, type of complications, patient age, stricture length, location and etiology. Complications considered significant were acute urinary retention or difficult catheterization requiring emergent urologic intervention or renal failure, urosepsis, or urethral abscess directly related to urethral stricture. Patients without complete data were excluded from study. The occurrence of complications was compared in relation to patient age, symptoms, stricture length, location, and etiology using binary logistic regression.
Results: Of 1023 patients meeting study criteria, mean patient age was 48.0 years and mean stricture length was 5.0cm (1-18). Stricture etiology was idiopathic (46.3%), iatrogenic (15.0%), lichen sclerosus (14.9%), trauma (12.1%), hypospadias (6.9%), and radiation (4.8%). The most common stricture location was bulbar (65.6%) followed by penile (18.6%), multi-segment (10.6%) and posterior (5.4%). 40.6% (415) of patients had at least one complication directly related to urethral stricture including acute urinary retention (32.6%), difficult catheterization (16.0%), urethral abscess/urosepsis (5.0%), and renal failure (3.1%). 7.0% of patients experienced complications deemed to be life-threatening. On multivariate analysis stricture length (in cm) (O.R.1.1; 95%CI 1.1-1.2, p=0.01), lack of reported LUTS (O.R. 3.8, 95%CI 1.9-7.3, p < 0.0001), posterior stenosis (O.R. 3.0, 95%CI 1.3-6.8, p=0.01), and traumatic strictures (O.R.1.6, 95% CI 1.1-2.4, p=0.02) were associated with complications related to urethral stricture. On multivariate analysis stricture etiology, particularly trauma (O.R.2.2, 95% CI 1.1-4.6, p=0.03) and hypospadias (O.R. 2.5, 95% CI 1.1-6.5, p=0.05) were associated with an increased risk of life-threatening complications.
Conclusions: Urethral stricture is frequently a morbid condition. Patients with longer strictures, posterior stenoses, absence of preceding LUTS and traumatic strictures are at highest risk for complications related to urethral stricture. Patients with these high-risk characteristics should perhaps be strongly encouraged to pursue definitive treatment.