J Urol. 2022 Apr 4:101097JU0000000000002688. doi: 10.1097/JU.0000000000002688. Online ahead of print.
ABSTRACT
OBJECTIVE: To determine the incidence of 90-day complications after urethroplasty and identify factors associated with them.
METHODS: A single-institution, two-surgeon retrospective review was performed on patients undergoing urethroplasty from 08/2003-06/2020. Variables included the incidence, type and Clavien-Dindo grade of complications, patient age, individual comorbidities, comorbidity component of the Charlson comorbidity index (CCI), smoking status, obesity (BMI ≥35), bacteriuria, type of urethroplasty, stricture etiology, length, location, prior endoscopic procedures, previous urethroplasty, and pre-operative suprapubic catheterization. The primary outcome was the incidence of significant 90-day complications defined as Clavien grade ≥2. Descriptive statistics were used to summarize the results and binary logistic regression was used to examine the factors associated with 90-day complications.
RESULTS: Of the 1611 patients included in the analysis, 90-day complications (Clavien ≥2) occurred in 7.9% (128/1611) and were wound-related (3.5%), urinary tract infection (3.4%), cardiovascular (0.4%), catheter-related (0.2%), hematuria (0.1%), or retention (0.1%). On univariable binary logistic regression stricture location (p=0.04), stricture length (p=0.009), CCI (p<0.0001), prior urethroplasty (p=0.01) and bacteriuria (p=0.002) were associated with complications while age (p=0.3), etiology (p=0.2), smoking (p=0.2), obesity (p=0.3), failed endoscopic treatment (p=0.8), indwelling suprapubic catheter (p=0.7) and type of urethroplasty (p=0.09) were not. On multivariable analysis, increasing CCI (Odds Ratio 1.31, 95%CI 1.10-1.56; p=0.003), prior urethroplasty (O.R.1.86, 95%CI 1.09-3.17; p=0.02) and pre-operative bacteriuria (O.R.1.67, 95%CI 1.14-2.45; p=0.009) remained associated with 90-day complications.
CONCLUSION: Patients with increased comorbidities, prior urethroplasty and pre-operative bacteriuria are at higher risk for complications after urethroplasty and should be counselled accordingly in a shared decision-making model of care.
PMID:35377776 | DOI:10.1097/JU.0000000000002688
