Criteria for patients offered perineal urethrostomy over urethroplasty for urethral strictures

Urethroplasty is considered the gold standard treatment for urethral stricture. Occasionally perineal urethrostomy can be offered to patients who cannot or are unwilling to undergo complex reconstruction. In this study, we explore the factors that have influenced urologists to offer perineal urethrostomy over urethroplasty for urethral strictures on the national level.

The American College of Surgeons National Surgical Quality Improvement Program database 2006-2021 was used to identify patients undergoing surgical procedures for urethral strictures using current procedural terminology (CPT) codes. The CPT codes for urethroplasty (53410) and perineal urethrostomy (53010) were used to analyze the data appropriately. Cases were excluded if they were missing any demographic data. Patient characteristics of interest were race, age, smoking status, obesity, hypertension (HTN), chronic obstructive pulmonary disease COPD, American Society of Anesthesiologists classification, use of glucocorticoids, history of cancer, and diabetes mellitus. The Chi-square and multivariate logistic regressions were used to identify significant predictors of outcomes. Significance was defined as P < 0.05.

In total, 2941 patients received urethroplasty, and 154 patients received perineal urethrostomy for urethral stricture. Patients with significant comorbidities such as diabetes mellitus, HTN, and COPD are significantly more likely to undergo perineal urethrostomy [Table 1]. Patients younger than 70 were more likely to undergo urethroplasty. History of cancer, congestive heart failure, race, and dialysis had no impact on the choice of repair here.

Male patients with urethral stricture who are less healthy and had increased comorbidities such as history of diabetes, HTN, and COPD were more likely to receive perineal urethrostomy over urethroplasty, while younger patients were less likely to be offered perineal urethrostomy.