Stricture Recurrence After Urethroplasty: A Systematic Review

Purpose

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.

Results

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.

Conclusions

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.

Key Words: urethral stricture, recurrence, urethra, penis

Abbreviations and Acronyms: AUA, American Urological Association, AUA-SS, AUA symptom score, BPH, benign prostatic hyperplasia, PVR, post-void residual, RUG, retrograde urethrogram, UTI, urinary tract infection, UU, urethral ultrasound, VCUG, voiding cystourethrogram