title: Repeat transurethral manipulation of bulbar urethral strictures is associated with increased stricture complexity and prolonged disease duration.
abstract: OBJECTIVE
  We examined the association of previous transurethral manipulation with stricture complexity and disease duration among men referred for bulbar urethral reconstruction.
  
  
  METHODS
  We retrospectively reviewed the records of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010. Only men treated with initial open surgery for bulbar strictures were included in analysis, thus excluding those with hypospadias, lichen sclerosus, pelvic radiation, prior urethroplasty, incomplete data, or pure penile or posterior urethral stenosis. Cases were divided into 2 groups based on the history of transurethral treatment for urethral stricture before urethroplasty, including group 1-0 or 1 and group 2-2 or greater treatments.
  
  
  RESULTS
  Of 101 patients with bulbar urethral stricture and all data available 50 and 51 underwent 0 to 1 and 2 or greater previous transurethral treatments, respectively. Repeat transurethral manipulation was strongly associated with longer strictures and the need for complex reconstruction. Repeat transurethral manipulation of bulbar urethral strictures was also associated with an eightfold increase in disease duration between stricture diagnosis and curative urethroplasty.
  
  
  CONCLUSIONS
  Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Hudak
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Atkinson
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
mesh_terms: D003251:Constriction, Pathologic; D004106:Dilatation; D004724:Endoscopy; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D014521:Urethra / Q000473:pathology / Q000601:surgery*; D014525:Urethral Stricture / Q000473:pathology / Q000601:surgery*