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Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence?

German Patino1, Andrew J Cohen2, Alex J Vanni3

  • 1Department of Urology, University of California-San Francisco, San Francisco, CA; Hospital San Ignacio, Bogota, Colombia.

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Summary
This summary is machine-generated.

Urinary extravasation after urethroplasty, identified via postoperative urethrogram, indicates a high risk of recurrence. Patients with extravasation require closer monitoring to manage potential urethral stricture disease.

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Area of Science:

  • Urology
  • Surgical Outcomes

Background:

  • Urethroplasty is a common surgical treatment for urethral stricture disease.
  • Postoperative monitoring is crucial to assess treatment success and detect recurrence.

Purpose of the Study:

  • To evaluate the significance of urinary extravasation on postoperative urethrogram for predicting recurrence after urethroplasty.
  • To determine the sensitivity and positive predictive value of postoperative urethrogram in identifying recurrence.

Main Methods:

  • Analysis of 1691 patients from the Trauma and Urologic Reconstructive Network of Surgeons database who underwent urethroplasty and postoperative urethrogram.
  • Definition of anatomic recurrence as <17 Fr stricture on 12-month cystoscopy and functional recurrence as need for secondary procedure within 1 year.
  • Assessment of primary outcomes including sensitivity, specificity, and positive/negative predictive values of postoperative urethrogram findings.

Main Results:

  • Among 1101 patients with follow-up, 54 (4.9%) showed extravasation on postoperative urethrogram.
  • Patients with extravasation had significantly higher rates of anatomic recurrence (74.1% vs 13%) and functional recurrence (9.3% vs 3.2%).
  • Extravasation was also associated with increased rates of urinary tract and wound infections.

Conclusions:

  • Postoperative urethrogram demonstrates high specificity but low sensitivity for predicting recurrence.
  • Urinary extravasation on postoperative urethrogram is a strong predictor of short-term recurrence and warrants increased patient monitoring.