Outcomes and Predictors of Reintervention Timing After Anterior Urethroplasty

Overview

This study evaluated long-term outcomes after anterior urethroplasty using anatomical, functional, patient-reported, and reintervention criteria. It highlights the variability in success rates depending on the criteria and emphasizes the importance of monitoring asymptomatic anatomical recurrences to predict future treatment needs.

Background

Urethroplasty success is traditionally defined by absence of reintervention, but this overlooks asymptomatic recurrences and patient reluctance for further treatment. Recent approaches advocate for multiple outcome measures including anatomical, functional, and patient-reported outcomes to better capture surgical success. There is no consensus on optimal follow-up duration or methods, though at least 12 months is recommended. Identifying predictors for reintervention remains a clinical challenge.

Data Highlights

The study included 138 male patients undergoing anterior urethroplasty with a mean age of 58 years and a median follow-up of 35 months (IQR 24.4–63.8). Follow-up assessments were conducted at 3, 6, 12, 24, and 60 months postoperatively, including urine cultures, uroflowmetry, questionnaires, and anatomical evaluations via cystoscopy or retrograde urethrogram.

Key Findings

• Success was assessed by four criteria: anatomical patency, functional flow rate (>10 mL/s), absence of symptoms, and no need for reintervention.
• Asymptomatic anatomical recurrences were identified in approximately one-third of patients at one year postoperatively.
• Functional success was defined less strictly than some guidelines, acknowledging that up to 20% of patients may have suboptimal flow despite a patent urethra.
• Patient-reported outcomes were measured using validated Spanish versions of USS-PROM and IIEF-5 questionnaires, capturing quality of life and satisfaction.
• Long-term follow-up with cystoscopy or RUG at multiple intervals allowed detection of recurrences that might otherwise be missed clinically.

Clinical Implications

Clinicians should incorporate multiple outcome measures beyond reintervention rates to accurately assess urethroplasty success. Routine anatomical evaluation, even in asymptomatic patients, is important to identify recurrences early and guide timely intervention. Using patient-reported outcomes alongside objective measures can improve individualized patient management and counseling.

Conclusion

A comprehensive, multimodal approach to outcome assessment after anterior urethroplasty reveals a spectrum of success rates and highlights the need for vigilant long-term follow-up to anticipate and manage anatomical recurrences. This strategy may optimize patient care and reduce delayed reinterventions.

References

1. YAU Reconstructive Working Group and stricture-fecta consensus
2. Trauma and Urologic Reconstructive Network of Surgeons (TURNS) 2014
3. Spanish validated USS-PROM and IIEF-5 questionnaires