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    Urethroplasty delay results in more complex repair

    <43-day wait time recommended for minimizing patient morbidity

     

    Impact of prolonged wait time examined

    Separately, investigators from the University of Alberta, Edmonton, analyzed the incidence and predictors of complications due to urethral stricture among men waiting for urethroplasty at their institution. Their retrospective review, published online in the Journal of Urology (Sept. 9, 2017), included 276 men who were operated on from 2009 to 2013.

    The men had a median age of 44 years, and their strictures were predominantly bulbar (67%) with a median length of 4 cm. Most men were catheter-free, but 11% were being managed with a suprapubic catheter and 1.5% were performing clean intermittent catheterization (CIC). Eighty-three percent had failed a prior endoscopic procedure and 2% had failed previous urethroplasty.

    The median interval from when the decision was made to have urethroplasty and the procedure was performed was 151 days. During that wait time, 44 men (16%) experienced a complication at a median of 43 days.

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    Urinary tract infection requiring antibiotic treatment was the most common complication (57%) followed by acute urinary retention (21%), catheter-related issues (16%), and acute genitourinary pain not attributable to infection or catheterization (7%). In a univariate analysis, catheter dependence, number of prior endoscopic treatments, and longer surgical wait time were predictors of complications. For the multivariate analysis, catheter-dependent status was stratified by catheter type, and both CIC and having a suprapubic tube were independent predictors of complications, increasing the risk 6.5-fold and 5.2-fold, respectively. Previous urethroplasty, which showed a trend to being a predictor in the univariate analysis (p=.06), was also an independent predictor of complications in the multivariate analysis, increasing risk by 1.6-fold.

    A Kaplan-Meier analysis estimating freedom from complications corroborated the findings of the multivariate analysis, showing that patients without a catheter had a much better complication profile than their counterparts managed with either CIC or a suprapubic tube.

    “Wait lists for urethroplasty at centers in America, Canada, and Europe are increasing. We believe ours is the first study to look at the morbidity of urethroplasty wait times,” said Nathan Hoy, MD, urology resident at the University of Alberta, who worked on the study with Keith Rourke, MD, and colleagues.

    “Our findings suggest that to minimize morbidity, urethroplasty wait time should be less than 43 days and that scheduling should be prioritized for patients with prior urethroplasty and catheters because they appear to be more likely to develop a stricture-related complication,” Dr. Hoy said.

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