Study justifies endoscopic urethrotomy as the initial treatment choice for urethral strictures
Austria: Results from a long-term population-based study confirm the suitability of endoscopic management as the initial treatment choice for appropriately selected patients with urethral stricture disease. The study, published in the BJU International suggests that the invasive re-treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.
The data provide real-world statistics on retreatment rates and average time to recurrence. Urologists should use these data to better counsel patients on the possible risks and benefits of urethrotomy. The study was limited by minimal information on the strictures — length and location.
Stephan Madersbacher, Department of Urology, Klinik Favoriten, Wien, Austria, and colleagues aimed to determine the long-term outcome of endoscopic urethrotomy for primary urethral strictures based on a population-based approach.
For this purpose, they analyzed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. They followed all the patients individually for 7–9 years. They documented frequencies and types of surgical re-interventions. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end-to-end urethral anastomosis.
A total of 1203 men underwent urethrotomy during the index period. The median patient age was 63 years. A total of 136 patients (11%) died during follow-up.
Following were the key findings from the study:
- Within the follow-up period, 78% received no further surgical re-intervention for recurrent disease, and 14.6% patients required one, 4.5% required two, and 3.4% required three or more procedures.
- The mean number of re-interventions was 1.5/patient and the lowest re-intervention rate was in patients aged ≥80 years (13.9%).
- In 68% of the cases at least one repeat urethrotomy was performed.
- An open reconstruction was performed in 32% cases, with urethroplasty in 24% patients, and end-to-end anastomosis in 76% patients.
- The mean interval until re-intervention was 29.5 months.
The authors concluded, "This long-term population-based study suggests that the invasive re-treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort."
Reference:
The study titled, "The long-term outcome of urethrotomy for primary urethral strictures: a population-based analysis," is published in the journal BJU International.
DOI: https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15347
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