title: Risk Factors and Timing of Early Stricture Recurrence After Urethroplasty.
abstract: OBJECTIVE
  To compare recurrence after urethroplasty, identifying associated risk factors for early recurrence.
  
  
  METHODS
  Among 262 urethroplasties (2001-2010) with ≥6 months of follow-up, we identified 65 patients (24.8%) with recurrence (defined by obstruction in the area of repair on cystoscopy).
  
  
  RESULTS
  Median stricture length was 4.5 cm (range 1-24 cm). Median follow-up was 85.2 (6.7-160.1) months, with median time to recurrence of 8.0 (0.5-88.0) months. Substitution urethroplasty was the most frequent repair (70.8%), followed by excision and primary anastomosis (23.1%). When graft was used, buccal was most common (66.0%), followed by abdominal wall skin (AWS) (24.5%). Twenty-one percent of recurrences presented within 3 months, 40.0% by 6 months, 55.4% by 1 year, whereas 9.2% recurred more than 5 years later. Recurrences ≤6 months were significantly longer strictures (median 5.5 cm vs 4.0 cm, P = .009). Strictures ≤4 cm, ≤3 cm, and ≤2 cm recurred at a median of 10.6, 18.2, and 30.3 months, respectively (P = .08). Most lichen sclerosis (LS)-related recurrences occurred within 6 months (62%). Patients recurring within 6 months were older, had history of LS, or more likely had AWS. Forty percent suffered from multiple recurrences at a median of 12 months and were associated with longer stricture, prior instrumentation, substitution urethroplasty, AWS, and LS.
  
  
  CONCLUSIONS
  Half of recurrences following urethroplasty present within one year, with most declaring within 6 months. Early recurrence is associated with older age, LS, AWS and longer strictures. The duration and intensity of surveillance protocols following urethroplasty should be individualized in order to account for these characteristics.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Joceline S
authors.initials: JS
authors.lastname: Liu
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Caroline
authors.initials: C
authors.lastname: Dong
authors.affiliation: Department of Urology, Case Western Reserve University, Cleveland, OH. Electronic address: Christopher.Gonzalez@UHhospitals.org.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods