is accompanied by
Urethroplasty remains the gold standard for the management of urethral stricture disease with acceptable long-term success. However, the standard by which stricture recurrence is defined and evaluated after urethral reconstruction remains widely variable. We conducted a systematic review of the urological literature to determine how stricture recurrence is defined and evaluated.
Materials and Methods:
A systematic review was conducted on all contemporary urethroplasty articles published between 2000 and 2008. Using the term “urethroplasty” 302 articles were identified and evaluated. A total of 86 articles were included in the analysis.
The overall recurrence rate for all reconstructive procedures was 15.6%, which remained stable between 2000 and 2008. Stricture recurrence was determined by a mean of 3 (range 1 to 8) different diagnostic tests. The most common primary diagnostic tests for recurrence were uroflowmetry (56% of articles) and retrograde urethrography (51%). Cystourethroscopy was used as a primary screen to identify stricture recurrence in 25% of articles, and as a secondary procedure in another 21%. Recurrence was defined as the need for an additional surgical procedure or dilation in 75% and 52% of articles, respectively.
The methods used to determine stricture recurrence after urethroplasty remain widely variable. The use of a standardized surveillance protocol to define stricture recurrence after urethral reconstruction may allow more effective comparison of urethroplasty outcomes across institutions.
- 1 : Urethral reconstruction. Curr Opin Urol2006; 16: 391. Google Scholar
- 2 : What is the place of internal urethrotomy in the treatment of urethral stricture disease?. Nat Clin Pract Urol2005; 2: 538. Google Scholar
- 3 : What is the best technique for urethroplasty?. Eur Urol2008; 54: 1031. Google Scholar
- 4 : Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol2005; 173: 1206. Link, Google Scholar
- 5 : Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int2004; 94: 867. Google Scholar
- 6 : Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience. J Urol2007; 178: 2006. Link, Google Scholar
- 7 : Cadaveric anatomy of pelvic fracture urethral distraction injury: most injuries are distal to the external urinary sphincter. J Urol2005; 173: 869. Link, Google Scholar
- 8 : Prospective evaluation of the American Urological Association symptom index and peak urinary flow rate for the followup of men with known urethral stricture disease. J Urol2002; 168: 2051. Link, Google Scholar
- 9 : American Urological Association symptom index in the assessment of urethroplasty outcomes. J Urol1998; 159: 1192. Link, Google Scholar
- 10 : Complications following urethral reconstructive surgery: a six year experience. Int Braz J Urol2008; 34: 594. Google Scholar
- 11 : Urinary prophylaxis and postoperative care of children at home with an indwelling catheter after hypospadias repair. Urology1988; 32: 418. Google Scholar
- 12 : Urinary retention and post-void residual urine in men: separating truth from tradition. J Urol2008; 180: 47. Link, Google Scholar
- 13 : Longitudinal changes in post-void residual and voided volume among community dwelling men. J Urol2005; 174: 1317. Link, Google Scholar
- 14 : The day-to-day variation (test-retest reliability) of residual urine measurement. Br J Urol1996; 77: 192. Google Scholar
- 15 : Post-void residual urine volume is not a good predictor of the need for invasive therapy among patients with benign prostatic hyperplasia. J Urol2006; 175: 213. Link, Google Scholar
- 16 : Reproducibility of uroflow measurement: experience during a double-blind, placebo-controlled study of doxazosin in benign prostatic hyperplasia. Urology1996; 47: 658. Google Scholar
- 17 : Variability and circadian changes in home uroflowmetry in patients with benign prostatic hyperplasia compared to normal controls. J Urol1992; 147: 1044. Link, Google Scholar
- 18 : Sonourethrography in the evaluation of urethral strictures: a preliminary report. J Urol1988; 139: 294. Link, Google Scholar
- 19 : A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures. Clin Radiol2004; 59: 736. Google Scholar
- 20 : Sono-urethrography in the evaluation of anterior urethral strictures. J Urol1995; 154: 72. Link, Google Scholar
- 21 : Imaging of the male urethra for stricture disease. Urol Clin North Am2002; 29: 361. Google Scholar
- 22 : Radiation exposure during standing voiding cystourethrography in women. Urology2006; 67: 269. Google Scholar
- 23 : Failed hypospadias repair presenting in adults. Eur Urol2006; 49: 887. Google Scholar
- 24 : Flexible cystoscopy in men: is topical anaesthesia with lignocaine gel worthwhile?. Br J Urol1994; 73: 155. Google Scholar
- 25 : Is antibiotic administration indicated after outpatient cystoscopy?. J Urol1988; 140: 316. Link, Google Scholar
Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois