title: Multivariate analysis of risk factors for long-term urethroplasty outcome.
abstract: OBJECTIVE
  We studied the patient risk factors that promote urethroplasty failure.
  
  
  METHODS
  Records of patients who underwent urethroplasty at the University of California, San Francisco Medical Center between 1995 and 2004 were reviewed. Cox proportional hazards regression analysis was used to identify multivariate predictors of urethroplasty outcome.
  
  
  RESULTS
  Between 1995 and 2004, 443 patients of 495 who underwent urethroplasty had complete comorbidity data and were included in analysis. Median patient age was 41 years (range 18 to 90). Median followup was 5.8 years (range 1 month to 10 years). Stricture recurred in 93 patients (21%). Primary estimated stricture-free survival at 1, 3 and 5 years was 88%, 82% and 79%. After multivariate analysis smoking (HR 1.8, 95% CI 1.0-3.1, p = 0.05), prior direct vision internal urethrotomy (HR 1.7, 95% CI 1.0-3.0, p = 0.04) and prior urethroplasty (HR 1.8, 95% CI 1.1-3.1, p = 0.03) were predictive of treatment failure. On multivariate analysis diabetes mellitus showed a trend toward prediction of urethroplasty failure (HR 2.0, 95% CI 0.8-4.9, p = 0.14).
  
  
  CONCLUSIONS
  Length of urethral stricture (greater than 4 cm), prior urethroplasty and failed endoscopic therapy are predictive of failure after urethroplasty. Smoking and diabetes mellitus also may predict failure potentially secondary to microvascular damage.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, California 94117, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.forename: Jack W
authors.initials: JW
authors.lastname: McAninch
authors.forename: Jared M
authors.initials: JM
authors.lastname: Whitson
authors.forename: Michael L
authors.initials: ML
authors.lastname: Eisenberg
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Mehdizadeh
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D055815:Young Adult