Evaluation of anterior urethral strictures based on histopathology and its correlation with outcome after urethroplasty.

BACKGROUND

Anterior urethral strictures significantly impact urinary function and quality of life, often requiring surgical intervention. This study evaluates the histopathological characteristics of strictures and their correlation with urethroplasty outcomes.

METHODS

A prospective study was conducted on 65 male patients (aged 20-60) diagnosed with anterior urethral strictures at SMS Medical College. Exclusion criteria included posterior urethral distraction defects and prior surgical interventions. Biopsies from stricture sites were analyzed for lichen sclerosus (LS) and inflammation. Urethroplasty techniques included dorsal augmentation, ventral onlay buccal mucosal graft, Asopa's dorsal inlay, and staged urethroplasty. Statistical analysis was performed using the chi-square test, independent t-test, and ANOVA, with a significance threshold of p < 0.05.

RESULTS

The majority of strictures were idiopathic (46.1%), followed by LS (26.1%) and iatrogenic causes (21.5%). LS was significantly associated with poorer surgical outcomes (p = 0.032). Severe inflammation within the stricture segment correlated with unsuccessful urethroplasty outcomes (p = 0.027), whereas inflammation in proximal or distal segments showed no impact. Stricture length > 8 cm also exhibited higher failure rates. The most common postoperative complication was wound infection (13.8%).

CONCLUSION

LS and severe inflammation are key predictors of unsuccessful urethroplasty outcomes. Histopathological evaluation should be integrated into preoperative assessment to optimize surgical planning and reduce recurrence rates. Future studies with larger cohorts and extended follow-ups are warranted to validate these findings.