1 HOW DO MEN PRESENT WITH URETHRAL STRICTURE DISEASE? THE CASE FOR A DISEASE SPECIFIC INSTRUMENT TO MEASURE OUTCOMES

INTRODUCTION AND OBJECTIVES: Available questionnaires evaluating lower urinary tract symptoms, such as the American Urological Association symptom index (AUASI) are not specific to urethral stricture disease (USD) and may not capture the spectrum of complaints of men with USD. Instruments specific to USD may be required for prospective research into outcomes of urethral reconstruction. We evaluated all symptoms of men with USD presenting for urethroplasty, both assessed and not assessed by the AUASI. METHODS: We performed a retrospective review of all patients who underwent urethroplasty by one surgeon at a single institution from 3/2001 to 6/2010. All presenting complaints related to urinary and sexual function were recorded. Obstructive symptoms were defined as weak stream, incomplete emptying, straining, and intermittency. Irritative symptoms were defined as frequency, urgency, and nocturia. Correlation of symptoms with respect to stricture etiology, length, and location was performed. RESULTS: Symptoms from 225 patients based on etiology are shown in table 1. The most common presenting complaints were weak stream (47%) and urinary retention (38%). Some 10% were asymptomatic. Over one-third (35%) presented with symptoms not addressed by the AUA SI; the most common symptoms were spraying (12%) and dysuria (10%). Age and stricture length did not correlate with specific symptoms. Men with penile USD were more likely to complain of spraying of urine stream (17% v 5.4%, p 0.006). Men with lichen sclerosis presented more frequently with obstructive symptoms (81% v 55%, p 0.04), erectile (ED) and/or ejaculatory (EjD) dysfunction (24% v 9.8%, p 0.05), and dysuria (33% vs 27%, p 0.01) but were less likely to present in urinary retention (0% v 20%, p 0.02). Men with strictures related to failed hypospadias repair were more likely to present with EjD or ED (23% v 9.3%, p 0.03) but less likely to present with dysuria (3.3% v 17%, p 0.04). CONCLUSIONS: While the AUA SI captures the most common complaints of men with USD, one-third of patients undergoing urethroplasty did not have symptoms assessed by the AUA SI, especially those related to urinary stream, dysuria, and sexual dysfunction. A validated, disease-specific instrument for USD is necessary to fully measure the symptoms and outcomes of urethral reconstruction.