Predictors of Urethral Stricture Recurrence After Urethroplasty

Characterization of preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty is of paramount importance. Urethral stricture is a prevalent health problem with high socio-economic impact on developed countries’ health budgets. Urethral strictures classically present with lower urinary tract symptoms and acute urinary retention. However, a proportion of men may present with a life-threatening condition. The most common etiologies differ worldwide, with causes of stricture classified as: iatrogenic, traumatic, lichen sclerosus, infectious, hypospadias, radiation exposure and idiopathic. They may occur anywhere along the urethra, defined as spongiofibrosis of the anterior (pendulous/bulbar, about 15 cm in length) urethra or as a posterior (membranous/prostatic, about 3 cm) urethral stenosis. Several treatment strategies, including dilation and direct visual internal urethrotomy (DVIU) have been widely used and recommended as first, minimally invasive options with which most urethrals strictures should be initially treated. However, urethroplasty has emerged as the most cost-effective management option for most strictures, especially those that have failed conservative endoscopic treatments, and remains the gold standard for longer, complex or recalcitrant strictures. However, failures do occur, depending on several risk factors (or predictors), including the type of urethroplasty employed, and predictors related to both patient and surgeon. In this chapter we try to characterize factors that are associated with stricture recurrence.