Long-term results of surgery for urethral stricture: A statistical analysis

Purpose: We assessed the long-term results of surgery for urethral stricture by statistical methods using guidelines for survival analysis. Materials and Methods: Of the 267 patients who underwent surgery for urethral strictures between March 1993 and December 1999, 238 (89%) were followed prospectively. The primary end point was success rate of urethroplasty. Secondary end points were variables that might influence success rates. Survival data were analyzed by the Kaplan-Meier method and Cox regression using guidelines for survival analysis. Results: The success rate of all urethroplasties was 82% (95% CI 66 to 89) at 7.5 years. A 6.5-year success rate of 86% (95% CI 70 to 95) was achieved by flap, of 86% (95% Cl 66 to 100) by anastomotic, of 79% (95% Cl 64 to 94) by mesh graft and of 56% (95% Cl 20 to 100) by graft urethroplasty. No significant difference was found among the surgical procedures using the log rank (p = 0.269) or Gehan-Wilcoxon (p = 0.259) test. Multivariate analysis showed an increased risk of failed urethroplasty in patients previously treated with urethral stents (HR 3.69, 95% CI 1.27 to 10.8) and by 2 or more urethrotomies (HR 2.25, 95% CI 1.05 to 4.8). Conclusions: Using standardized success criteria and statistical methods that applied guidelines for survival analysis conclusions were drawn. Excellent results are achievable by all forms of urethroplasty, justifying a more liberal indication for urethral reconstruction.