Impact of Cardiovascular and Metabolic Risk Factors on Stricture Recurrence After Anterior One-stage Buccal Mucosal Graft Urethroplasty

TY - JOUR

T1 - Impact of Cardiovascular and Metabolic Risk Factors on Stricture Recurrence After Anterior One-stage Buccal Mucosal Graft Urethroplasty

AU - Meyer, Christian P

AU - Lamp, Jule

AU - Vetterlein, Malte W

AU - Soave, Armin

AU - Engel, Oliver

AU - Dahlem, Roland

AU - Fisch, Margit

AU - Kluth, Luis A

N1 - Copyright © 2020 Elsevier Inc. All rights reserved.

PY - 2020/12

Y1 - 2020/12

N2 - OBJECTIVES: To evaluate the impact of cardiovascular, metabolic and smoking related risk factors on recurrence in patients with buccal mucosal graft urethroplasty for anterior urethral strictures.PATIENTS AND METHODS: Retrospective single-center analysis between 2009 and 2016. Covariates included American Society of Anesthesiology (ASA) score, body mass index, and smoking status (never vs ever), coronary artery disease, arterial hypertension, diabetes mellitus, change in hemoglobin, creatinine, c-reactive protein, and leucocyte count. Descriptive and survival analyses evaluated the association with stricture recurrence.RESULTS: Overall, 1039 patients had buccal mucosal graft urethroplasty of which 517 remained for final analysis. Patients with stricture recurrence (n = 76) were significantly older (P < .001), had a higher American Society of Anesthesiology score (P = .006), higher proportion coronary artery disease (P = .011), and hypertension (P = .003) compared to those patients without stricture recurrence. Patients without stricture recurrence had a significantly larger drop in hemoglobin (1.5 [0.9, 2.1] vs 1.2 [0.7, 1.8]) mg/dl ( = .005).Overall stricture-free recurrence rate was 86%, with a median follow-up of 32 (95% confidence interval: 26-30) months. In multivariable analysis, a larger drop of hemoglobin remained the only independent, statistically significant negative predictor of stricture recurrence (Hazard ratio, 95% confidence interval: 0.74, 0.57-0.97, P = .03).CONCLUSION: A larger drop of hemoglobin is independently associated with recurrence free survival. This may be considered as a surrogate marker for good microvascular circulation of the corpus spongiosum and therefore neovascularization of the graft. Contrary to the existing and mostly heterogenous previous studies, our findings suggest that stricture recurrence is largely independent of cardiovascular and metabolic risk factors.

AB - OBJECTIVES: To evaluate the impact of cardiovascular, metabolic and smoking related risk factors on recurrence in patients with buccal mucosal graft urethroplasty for anterior urethral strictures.PATIENTS AND METHODS: Retrospective single-center analysis between 2009 and 2016. Covariates included American Society of Anesthesiology (ASA) score, body mass index, and smoking status (never vs ever), coronary artery disease, arterial hypertension, diabetes mellitus, change in hemoglobin, creatinine, c-reactive protein, and leucocyte count. Descriptive and survival analyses evaluated the association with stricture recurrence.RESULTS: Overall, 1039 patients had buccal mucosal graft urethroplasty of which 517 remained for final analysis. Patients with stricture recurrence (n = 76) were significantly older (P < .001), had a higher American Society of Anesthesiology score (P = .006), higher proportion coronary artery disease (P = .011), and hypertension (P = .003) compared to those patients without stricture recurrence. Patients without stricture recurrence had a significantly larger drop in hemoglobin (1.5 [0.9, 2.1] vs 1.2 [0.7, 1.8]) mg/dl ( = .005).Overall stricture-free recurrence rate was 86%, with a median follow-up of 32 (95% confidence interval: 26-30) months. In multivariable analysis, a larger drop of hemoglobin remained the only independent, statistically significant negative predictor of stricture recurrence (Hazard ratio, 95% confidence interval: 0.74, 0.57-0.97, P = .03).CONCLUSION: A larger drop of hemoglobin is independently associated with recurrence free survival. This may be considered as a surrogate marker for good microvascular circulation of the corpus spongiosum and therefore neovascularization of the graft. Contrary to the existing and mostly heterogenous previous studies, our findings suggest that stricture recurrence is largely independent of cardiovascular and metabolic risk factors.

U2 - 10.1016/j.urology.2020.07.073

DO - 10.1016/j.urology.2020.07.073

M3 - SCORING: Journal article

C2 - 32950595

VL - 146

SP - 253

EP - 259

JO - UROLOGY

JF - UROLOGY

SN - 0090-4295

ER -