Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study

doi:10.1016/j.ajur.2023.04.006

Asian Journal of Urology, 2024, 11 (3): 480-485 doi: 10.1016/j.ajur.2023.04.006

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Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study

Ahmed M. Abdel Gawad^a,b,Abhijit Patil^a,Abhishek Singh^a,Arvind P. Ganpule^a,*(

),Ravindra B. Sabnis^a,Mahesh R. Desai^a

^aDepartment of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
^bDepartment of Urology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt

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Abstract

Objective: To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation (BD) for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.

Methods: This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019. Data about the patient age, stricture characteristics, and recurrence date were recorded, along with information on postoperative indwelling catheter use and operative complications. Furthermore, information about the self-calibration procedure was collected and where available, free flow (FF) measurements during the follow-up period were recorded and analyzed. Success was defined as a lack of symptoms and acceptable FF rates (maximum flow rate>12 mL/s).

Results: The final analysis was conducted on 187 patients. The mean follow-up period was 37 months. The long-term overall success rate at the end of our study was 66.8%. Our recurrence rate was 7.4% at 12 months, 24.7% at 24 months, and reached 33.2% at the end of our study. The time to recurrence ranged from 91 days to 1635 days, with a mean of 670 days. The stricture-free survival was significantly shorter with lengthy peno-bulbar (p=0.031) and multiple strictures (p=0.015), and in the group of patients who were not committed to self-calibration protocol (p<0.011). However, post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence (odds ratio=5.85). Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4% in the non-self-calibration group to 15.1% in the self-calibration one (p<0.001), but also improved the overall stricture-free survival and FF parameters.

Conclusion: Urethral BD has a high recurrence rate in the long-term, especially with long and multiple strictures. Adjuvant self-calibration has proven to reduce the recurrence risk and the need for re-intervention.

Key words： Balloon dilation Internal urethrotomy Recurrence Self-calibration Urethral stricture

Received: 08 November 2022 Available online: 20 July 2024

Corresponding Authors: *E-mail address: doctorarvind1@gmail.com (A.P. Ganpule).

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	Ravindra B. Sabnis
	Mahesh R. Desai

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Cite this article:

Ahmed M. Abdel Gawad,Abhijit Patil,Abhishek Singh, et al. Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study[J]. Asian Journal of Urology, 2024, 11(3): 480-485.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.04.006 OR http://www.ajurology.com/EN/Y2024/V11/I3/480

Baseline (patient and stricture) characteristics, and overall procedural outcomes.

FF parameters.

Kaplan-Meier curves predicting the time to recurrence by stricture locations. p=0.031 (log-rank [Mantel-Cox] test).

Kaplan-Meier curves predicting the time to recurrence by number of strictures. p=0.015 (log-rank [Mantel-Cox] test).

Kaplan-Meier curves predicting the time to recurrence by the treatment group. p<0.011 (log-rank [Mantel-Cox] test).

Peri-operative categorical variables tested against the risk of recurrence.

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