Presentation Authors: Anthony Yang*, Michael Palese, New York, NY
Introduction: We aim to characterize and determine predictors of urethral stricture recurrence following urethroplasty. This is the largest study to evaluate predictors of recurrence and first to include provider characteristics.
Methods: Patient who underwent urethroplasty between 1995 and 2015 were identified from the Statewide Planning and Research Cooperative System (SPARCS) database, a comprehensive all-payer reporting system containing patient level data on all hospital discharges in New York State. Recurrence and repeat urethroplasty were identified by linking subsequent discharges. The chi-square test was used to compare variables. Multivariable logistic regression was used to determine predictors of recurrence and repeat urethroplasty.
Results: 1,481 patients undergoing urethroplasty were identified between 1995 and 2015. 1,285 (87%), 132 (9%) and 64 (4%) underwent primary anastomosis, buccal graft and other graft urethroplasty, respectively. 158 (11%) patients experienced recurrence, and of these patients, 95 (6%) underwent repeat urethroplasty. The average time from the initial urethroplasty to recurrence and repeat urethroplasty were 848 and 808 days, respectively. The majority (53.8%) of recurrence occurred within 1 year. Multivariable analysis demonstrated that risk factors for urethral stricture recurrence were race (OR black vs. white: 1.77, CI: 1.1, 2.8, p=0.014), age (OR: 1.01, CI: 1, 1.03, p=0.001) and income (OR: 25-50th percentile vs top quartile: 1.69, CI: 1.01, 2.83, p=0.044). Of the patients with recurrence, insurance (OR Medicaid vs. private insurance: 0.25, CI: 0.07, 0.86, p=0.027) was the only predictor of urethroplasty. Other patient characteristics, provider characteristics and use of graft did predict recurrence.
Conclusions: Urethroplasty is a robust treatment for urethral stricture with 91% of patients requiring only primary repair without the need for second stage or repeat urethroplasty. Predictor of recurrence include race, age and income. Graft usage, surgeon volume and hospital characteristics are not associated with recurrence.