Defining Long-term Success after Anterior Augmentation Urethroplasty: 10-yr Patient-reported and Objective Outcomes According to the Novel Stricture-fecta Criteria.

BACKGROUND AND

OBJECTIVE

There is a paucity of long-term data on patient-reported outcome measures (PROMs) after urethroplasty. We aimed to evaluate PROMs and retreatment-free survival more than 10 yr after anterior augmentation urethroplasty, using the recently established stricture-fecta criteria for standardized outcome reporting.

PATIENTS AND

METHODS

We retrospectively identified 97 men who underwent anterior augmentation urethroplasty between 2010 and 2013. Stricture characteristics were classified according to the Length, Segment, and Etiology system. Follow-up was performed via structured telephone interviews, and consenting patients completed a validated online survey at a single cross-sectional time point more than 10 yr after surgery. The survey included the Urethral Stricture Surgery (USS) PROM as well as instruments for urinary incontinence (ICIQ-UI SF), erectile function (IIEF-EF), and ejaculatory function (MSHQ-Ej). Retreatment-free survival was estimated using Kaplan-Meier analysis. The endpoints investigated met the trifecta criteria of standardized urethroplasty outcome reporting (stricture-fecta).

KEY FINDINGS AND LIMITATIONS: Median follow-up in 97 patients was 136 mo (95% confidence interval 133-138). Most strictures were >2 and ≤7 cm (66%) and bulbar (64%), predominantly iatrogenic (42%) or idiopathic (38%). Single-stage repair was performed in 90%. In total, 17 patients (18%) experienced recurrence, yielding 2-, 5-, and 10-yr retreatment-free survival rates of 90%, 86%, and 84%, respectively. Median USS PROM lower urinary tract symptoms score was 5/24, median ICIQ-UI SF 0/21, median IIEF-EF 19/30 (median modified IIEF-EF 24/30), and median MSHQ-Ej 28/35, indicating low urinary symptom burden and preserved sexual function. Mean EuroQol 5-Dimension (EQ-5D) index and EuroQol Visual Analogue Scale (EQ-VAS) were 0.936 and 78. Overall, 92% of patients reported being satisfied or very satisfied with their long-term outcomes. Limitations include the cross-sectional nature of long-term follow-up and potential nonresponse bias.

INTERVENTION: Augmentation urethroplasty.

CONCLUSIONS AND CLINICAL IMPLICATIONS: This first report of PROMs beyond 10 yr after anterior urethroplasty demonstrates durable retreatment-free survival, excellent long-term urinary and sexual function, and sustained patient satisfaction, providing a robust benchmark for current and emerging treatments.