title: Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties.
abstract: BACKGROUND
  We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty.
  
  
  METHODS
  We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr on cystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression.
  
  
  RESULTS
  In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence.
  
  
  CONCLUSIONS
  Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kinnaird
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB.
authors.forename: Max A
authors.initials: MA
authors.lastname: Levine
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB.
authors.forename: Druvtej
authors.initials: D
authors.lastname: Ambati
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB.
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Zorn
authors.affiliation: Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB.
authors.forename: Keith F
authors.initials: KF
authors.lastname: Rourke