Jill Stein

May 14, 2011

May 14, 2011 (Washington, DC) — New data demonstrate a wide variation in surveillance practices among urologic reconstruction experts after they perform a urethroplasty.

"Even among experts, there is no consensus or standard evaluation protocol for follow-up after urethroplasty," Lawrence Yeung, MD, a fellow in reconstructive urology at Washington University School of Medicine in St. Louis, Missouri, reported here at the American Urological Association 2011 Annual Scientific Meeting.

The incidence of urethral strictures in the United States was 193 per 100,000 individuals in 2003, Dr. Yeung noted. Expenditures for the treatment of urethral stricture disease totaled $191 million in 2000.

The researchers analyzed the results of a questionnaire completed over a recent 3-month period by 90 urologists who were members of the Society of Genitourinary Reconstructive Surgeons. About one third of respondents performed 50 to 100 urethroplasties per year.

Results revealed a wide range of responses for the definition of a urethroplasty failure. Procedural failure was defined as the need for a secondary urethral procedure by 60.0% of experts who completed the survey, as significant narrowing on the retrograde urethrogram by 14.4%, as urethral narrowing that prevents passage of a 16 F cystoscope by 12.2%, and as voiding dysfunction as shown by poor uroflow or American Urologic Association symptom score (AUASS) by 7.8%.

The survey also showed that 10% of respondents did not obtain routine imaging studies (voiding urethrocystogram and retrograde urethrogram) at the time of catheter removal to rule out an anastomotic leak.

In addition, only one third of respondents followed their patients for longer than 3 years after surgery.

Urowflometry was used by 85.4% of respondents to screen for structure recurrence, postvoid residual by 56.2%, AUASS by 41.6%, urinalysis by 38.2%, flexible cystoscopy by 19.1%, and retrograde urethrography by 16.9%. There was no consensus on the absolute change in flow rate to guide additional testing.

Nearly half (47.7%) of respondents did not use any validated instruments to evaluate quality of life, even though the procedure is indicated to improve quality of life. Overall, 40.9% used the AUASS, 19.3% used the Sexual Health Inventory for Men, and 10.2% used the International Index of Sexual Dysfunction.

Dr. Yeung said that the results underscore the need for standardized definitions for urethroplasty failure and follow-up protocols. Standardization will allow investigators to better compare surveillance methods, with a goal of improving long-term outcomes.

American Urological Association (AUA) 2011 Annual Scientific Meeting: Abstract 3. Presented May 14, 2011.