Objective
To determine if age is an independent predictor of surgical success in patients undergoing
urethroplasty. Urethroplasty performed by excision and primary anastomosis depends
on vascular collateralization. Successful augmented urethroplasty depends on graft
neovascularization. Older patients have more comorbid conditions including peripheral
vascular disease associated with reduced penile blood flow.
Methods
This is a retrospective review of urethroplasties from 11 institutions. Primary outcome
was functional success at 1 year from surgery, defined as freedom from post-urethroplasty
procedures. Secondary outcome was freedom from cystoscopic evidence of stricture recurrence
at 3 months. Study outcomes were compared between 2 age cohorts (<60 years old and
≥60 years old). Multivariable logistic regression analysis evaluated the influence
of patient factors on our primary and secondary outcomes, using age as a continuous
variable.
Results
Of 322 urethroplasties, 258 were performed in patients <60 years and 64 in patients
≥60 years. Median follow-up was 1.8 years. The following were not significantly different
between groups: stricture length or location, smoking status, number of previous urethrotomies
or dilations, and urethroplasty type. The following were more common in patients ≥60
years: diabetes, hypertension, hyperlipidemia, coronary artery and peripheral vascular
disease, chronic obstructive pulmonary disease, and cancer. There was no difference
in need for repeat procedures or anatomic recurrence between age groups or with increasing
age. Stricture length was the only statistically significant clinical factor.
Conclusion
Urethroplasty success may be affected by comorbidities but not age. Age alone should
not be used as an absolute exclusion criterion for men needing urethral reconstruction.
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Article info
Publication history
Published online: June 01, 2017
Accepted:
March 21,
2017
Received:
December 21,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: The Joe W. and Dorothy Dorsett Brown Foundation provided support for this study.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
