AUA 2013: Stricture: Age, length heighten complication risk

A higher than expected rate of complications was seen among men with anterior urethral stricture, the authors of a retrospective study based on a large, single-practice cohort reported.

The study identified older men and those having longer strictures as being at particular risk.

Co-author Keith Rourke, MD, analyzed presenting features, complications, and potential risk factors for complications in a series of 611 patients who presented with anterior urethral stricture over a period of 6 years. Overall, 240 patients (39%) were identified as having one or more complications directly related to urethral stricture. Acute urinary retention was most common (30%), followed by difficult catheterization (14%), urethral abscess (7%), and renal failure (4%).

Potential risk factors investigated included patient age along with stricture length, etiology, location, and presenting symptoms. With patients divided into two groups according to whether they were younger or older than the cohort’s mean age, patients older than 50 years of age had a significantly higher rate of complications than their younger counterparts (44% vs. 36%).

Stricture length was also significantly associated with increased risk of complications, as the rate of complications was 50% among men whose stricture was 6 cm in length or longer versus 36% for those with shorter strictures.

“When patients develop stricture recurrence after initial endoscopic treatment, the decision to perform urethroplasty is predominantly based on providing symptomatic relief. Our study indicates that urethral stricture is a morbid condition for many patients, and we believe this information should also be taken into account when counseling patients about management,” said Dr. Rourke, of the University of Alberta, Edmonton.

“Even though the urethroplasty success rate may be potentially lower among men who are older and those with longer strictures, we believe these at-risk individuals would be best served by reconstruction and should be strongly encouraged to undergo definitive surgical treatment.”