Evaluation of wound complications after surgery for urethral strictures: the effect of testosterone deficiency

Kogan M.I., Amirbekov B.G., Sizyakin D.V., Mitusov V.V., Gluhov V.P., Il'yash A.V., Mirzaev Z.A., Ramazanov B.Yu.

Introduction. Wound complications (WC) in the surgery for urethral strictures (US) influence the end result and the clinical outcome. WC are connected with urinary tract infections, hematomas, neurogenic lesions and hemorrhages, and depend on the operation type. Patient-related factors, such as age, diabetes mellitus, metabolic syndrome, etc. also play a proven role in the development of WC.

Purpose: Determination of the hypothetical connection between deficiency of the serum testosterone (T) and the risk of WC development after surgery for US.

Materials and methods. The study included 40 males aged from 19 to 63 presented with US and selected for open surgical reconstruction plasty. In 30 (75%) cases, the US were due to injuries, and in 10 (25%) cases to inflammation. Ten patients had been earlier subjected to ≥ 2 operations for US, while the rest underwent primary urethral surgery. Resection of the urethra with end-to-end anastomosis was performed on 26 (65%) patients, and replacement urethroplasty on 14 (35%). In addition to the standard examinations, the serum T level was measured in all patients at 2-3 days before the operation, and at 1, 3, 7 and 14 days postoperatively.

Results. Initial testosterone deficiency was found in three patients (n=12). WC developed in 37.5% of cases. They were observed in every second male with Т ≤ 12.0 nmole/l and in every third male with Т ≥12.1 nmole/l. The number of WC was twice greater in hypogonadal males (21) in comparison with normogonadal cases (10). The risks of WC in hypogonadal males in comparison with the normogonadal patients were consistently 4 times higher at an age of > 40, 4.9 times higher in case of traumatic strictures, 3.7 times higher in case of primary surgery for US, and 4.7 times higher in case of urethral resection. Recurrent US during the 12-month follow-up period were found in 3 patients (7.5%), two of whom had been initially hypogonadal, and one eugonadal.

Conclusion. Deficiency of Т is not a rare comorbidity in patients with US subjected to open surgical reconstruction plasty. Hypogonadism consistently raises the risks of WC in males over 40 years old with traumatic strictures after primary operations of the resection type.

Authors declare lack of the possible conflicts of interests

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urethral stricture, wound complications, testosterone, androgenic deficiency

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