Introduction. Multi-stage urethroplasty (≥ 2 stages) is performed in patients with the most complex strictures and obliterations of the spongy urethra. Moreover, this surgery is associated with high risks of complications including relapses.
Purpose. To identify risk factors for recurrent urethral strictures in multistage urethroplasty to determine the indications for urethroplasty or definitive urethrostomy.
Materials and methods. The study included 110 men aged 44 years (group I) who underwent multistage urethroplasty for the anterior urethra structures, and 48 men aged 60 years (group II) who underwent final (permanent) urethrostomy for the same reason. The average follow-up was 61 months. In group I, recurrent urethral strictures were diagnosed in 32 (29.1%) men, in group II, urethral stenosis was noted (p < 0.001) in 7 (14.9%) cases. The contribution of various factors to the development of recurrent urethral strictures was determined using univariate analysis by calculating the relative risk. Statistical significance was tested using the χ2 test. Multivariate analysis was performed by logistic regression scores.
Results. In a univariate analysis, comparing patients with recurrent strictures after multistage urethroplasty and relapse-free cases after permanent urethrostomy showed that the risks of recurrence after urethroplasty are associated with the age (41.3 versus 59.6 years; p < 0.001). previous surgical correction of hypospadias (OR = 6.6; 95% CI = 0.81 – 53.4; p = 0.04), multifocal localization (OR = 2.6; 95% CI = 1.0 – 6.93; p = 0.04) and length (8.8 versus 6.9 cm; p = 0.03) of urethral strictures. Multivariate data analysis revealed a joint variation of factors that negatively affect the result of multistage urethroplasty: surgical correction of hypospadias (HR = 38.5; p = 0.004), history of urethral dilatation (HR = 6.5; p = 0.005), length (HR = 1.2; p = 0.008) and multi-focus (HR = 6.3; p = 0.01) of urethral strictures, diabetes mellitus (HR = 13; p = 0.04).
Conclusions. Risk factors for recurrent urethral strictures in multistage urethroplasty are numerous and often combined. Pre-and postoperative analysis of these factors dictates the need to discuss the problem with the patient, including resolving the issue of choosing a permanent urethrostomy instead of urethroplasty.