Predictors of recurrence of urethral stricture disease following optical urethrotomy

Objective: To assess the predictors of recurrence in Optical urethrotomy (OU) for male urethral strictures. Methods: 148 male patients treated with OU with intent to treat during the period of January 2003-December 2008 were included in the study. Charts were reviewed for demographics, cause of stricture, stricture length and need for ancillary procedure following OU. The time to recurrence following OU was noted. All patients were evaluated postoperatively with uroflowmetry monthly for the first 3 months, every 3 months during year 1 and every 6 months during year 2. After year 2 most patients were followed annually. Results: 139 patients were included in the study, 9 were excluded for inadequate follow up. Median age was 54 years (17-87). The etiology of stricture was iatrogenic in 35%, unknown in 32%, inflammatory in 17% and secondary to external trauma in 16%. Majority (61%) were bulbar or bulbo membranous in location. For a mean follow up of 8.9 ± 11 months, the overall recurrence rate was 37%, with mean time to recurrence of 4.5 months. Stricture length (p = 0.0001), etiology (p = 0.001) and site (p = 0.017) were significant factors of recurrence. Conclusions: Strictures of penile urethra, following transurethral resection of prostate and length greater than 20 mm are significant causes of poor result for optical urethrotomy monotherapy. Patients with these predictors should preferably not be treated by OU.