MP13-09 TOWARDS OPTIMIZING THE OUTCOME OF DIRECT VISION INTERNAL URETHROTOMY: LONG-TERM RESULTS OF A LARGE CONTEMPORARY SERIES

INTRODUCTION AND OBJECTIVES: Direct vision internal urethrotomy (DVIU) is the first option for the treatment of short anterior urethral strictures. However, long-term outcome is not favorable. Our purpose is to determine patients at risk of recurrence in a large contemporary series. METHODS: We retrospectively analyzed the data sheets for adult patients (>18 years) underwent DVIU for urethral strictures between January 2002 and January 2013. Patients’ demographics and stricture characteristics by retrograde urethrography and operative findings were analyzed. The primary outcome is the development of failure defined as the need for any further intervention e.g. endoscopic or substitution after catheter removal. Univariable and multivariable analyses were used to identify patients at risk of failure. RESULTS: A total of 563 patients with a mean SD age of 49.9 15.9 years were analyzed during the specified period. The main cause of stricture was idiopathic in 51.9% and the strictures were multiple in 17 (12.4%) patients with median diameter and length of 2 mm and 6 mm, respectively. Recurrence developed in 128 (22.7%) patients over a median followup of 36 months (3-280). Patients developed recurrent strictures were obese (p 1⁄4 0.012). Post-traumatic and idiopathic strictures had higher incidence of recurrence than iatrogenic and inflammatory strictures (p 1⁄4 0.001) while distal strictures had significantly more tendency to recur than proximal strictures (p 1⁄4 0.01). None of the stricture characteristics by retrograde urethrography was significantly associated with recurrence. On binary logistic regression analysis, obese patients (OR: 1.7; p 1⁄4 0.013), distal strictures (OR: 2; p 1⁄4 0.011) and traumatic strictures (OR: 1.7; p 1⁄4 0.05) were independent predictors for stricture recurrence. Furthermore, distal strictures (b 1⁄4 0.1; p 1⁄4 0.016) and positive urine culture (b 1⁄4 0.1; p 1⁄4 0.012) were independent predictors for increased number of recurrence by linear regression. CONCLUSIONS: obese patients developed post-traumatic strictures at distal anterior urethra are at high risk for recurrence following DVIU. The presence of associated urinary tract infection increases the odds of recurrence frequency.