title: Lower urinary tract pain and anterior urethral stricture disease: prevalence and effects of urethral reconstruction.
abstract: OBJECTIVE
  Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We prospectively characterized lower urinary tract pain in association with urethral stricture disease and assessed the effects of urethroplasty on this pain.
  
  
  METHODS
  Men (18 years old or older) with anterior urethral stricture disease were prospectively enrolled in a longitudinal, multi-institutional, urethral reconstruction outcomes study from June 2010 to January 2013 as part of TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Preoperative and postoperative lower urinary tract pain was assessed by the validated CLSS. Voiding and sexual function was assessed using validated patient-reported measures, including I-PSS.
  
  
  RESULTS
  Preoperatively 118 of 167 men (71%) reported urethral pain and 68 (41%) reported bladder pain. Age was the only predictor of urethral pain with men 40 years or younger reporting more pain than those 60 years old or older (81% vs 58%, p = 0.0104). Lower urinary tract pain was associated with worse quality of life and overall voiding symptoms on CLSS and I-PSS (each p <0.01). Postoperatively lower urinary tract pain completely resolved in 64% of men with urethral pain and in 73.5% with bladder pain. There were no predictive factors for changes in lower urinary tract pain after urethral reconstruction.
  
  
  CONCLUSIONS
  Lower urinary tract pain is common in urethral stricture disease, especially in younger men. It is associated with worse quality of life and voiding function. In most men lower urinary tract pain resolves after urethral reconstruction.
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bertrand
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Warren
authors.affiliation: Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington.
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Elliott
authors.affiliation: Division of Urology, University of Utah, Salt Lake City, Utah.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Myers
authors.affiliation: Department of Urology, Ohio State University, Columbus, Ohio.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: McClung
authors.affiliation: Department of Biostatistics, University of Iowa, Iowa City, Iowa.
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: Oleson
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: brad-erickson@uiowa.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Erickson
mesh_terms: D000328:Adult; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D011446:Prospective Studies; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000150:complications* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
keywords: lower urinary tract symptoms; pain; quality of life; reconstructive surgical procedures; urethral stricture