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Urethral stricture after cardiovascular surgery, a retrospective and a prospective study
Insights
Urethral catheter use during cardiovascular surgery is linked to a higher incidence of urethral strictures. Suprapubic cystocatheters may offer a safer alternative for urinary diversion in these patients.
Area of Science:
- Urology
- Cardiovascular Surgery
Background:
- Urethral stricture is a recognized complication.
- A high incidence was observed following cardiovascular surgery.
Purpose of the Study:
- To investigate the etiologic factors of urethral stricture after cardiovascular surgery.
- To compare the incidence of strictures between urethral catheters and suprapubic cystocatheters.
Main Methods:
- Retrospective review of 87 urethral stricture cases and 304 cardiovascular surgery patients.
- Prospective study of 98 patients undergoing cardiovascular surgery.
- Comparison of stricture development in patients with urethral catheters versus suprapubic cystocatheters for urinary diversion.
Main Results:
- 17.5% of patients with urethral catheters developed strictures.
- No strictures were observed in patients with suprapubic cystocatheters.
- Urethral catheterization for urinary diversion appears to be a significant risk factor.
Conclusions:
- Urethral catheterization is a probable cause of urethral stricture formation post-cardiovascular surgery.
- Urethral ischemia may be a contributing factor.
- Suprapubic cystocatheters may reduce the risk of stricture development.
Abstract:
In a review of our cases presenting with urethral stricture we noted a high incidence following cardiovascular surgery. A retrospective study was done, including 87 patients treated for urethral stricture and 304 undergoing open heart surgery during the same period, to search for a possible etiologic factor. A prospective study also was done on 98 patients subjected to cardiovascular surgery. Strictures developed in 17.5 per cent of 63 patients who had a urethral catheter placed for urinary diversion at operation compared to none of 35 who had a suprapubic cystocatheter. We believe that the urethral catheter is at least partly responsible for stricture formation. Associated factors, for example urethral ischemia, may be contributory.
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