JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 35

Abstracts

P3-10 Aetiology, presentation and initial evaluation of urethral disease in the United Kingdom

P3-10: Table 2. The incidence of presentation with recurrent
stricture following previous urethroplasty in 4,032 men.

Payne S1, Fowler S1, Mundy T2
1BAUS, London, United Kingdom, 2University College Hospital
London, United Kingdom

Stricture site

Cases

Previous
urethroplasty

Penile
Meatus & Navicular fossa
Peno-bulbar
Bulbar
Bulbo-prostatic
Bladder neck

774
442
438
2,153
191
34

51.2%
31.8%
27.8%
11%
13.6%
2.9%

Objective: To determine the volume and its complexity
of urethral pathology presenting for reconstructive surgery in the UK.
Methods: Between June 2010 and the end of May 2017
4,809 men were enrolled onto a secure online data
platform with surgeon entered information being collected in 252 variable fields. Data regarding patient's
underlying urethral pathology, its aetiology, prior management, presenting symptoms and investigations was
collected as a prelude to investigation with a view to
surgical intervention.
Results: Surgeon data entry was 70.7% complete for
all men in the study. 94% of patients were referred with
stricture disease of which the vast majority was due to
uncomplicated disease in the bulbar urethra, peno-bulbar segment or penile urethra. 26% of strictures were
consequent upon either Lichen Sclerosis or previous
hypospadias surgery, both of which were responsible
for a large amount of revisional surgery, and physical
trauma, or complex iatrogenic trauma, caused 10% of
strictures and 22% of fistulae. Acute retention was a
surprisingly common form of presentation, especially
for men with posterior urethral or bladder neck strictures. Patients performing Clean Intermittent Selfdilatation (CISD) had a lower incidence of retention.
UK compliance with guidelines about initial management of the man with a recurrent urethral stricture,
and its evaluation, appears poor.
Conclusion: Online databases can provide very significant amounts of information about the aetiology and volumes of men demanding reconstructive urethral surgery.
They demonstrate patterns of disease and management
and indicate national compliance to accepted standards of
practice for urethral reconstruction.
P3-10: Table 1. The presumed predominant underlying cause
for urethral pathologies recorded in 4,398 men.
Cause of urethral problem

No identified cause
Lichen sclerosis
Hypospadias/previous
treatment
Physical/ complex
iatrogenic trauma
Catheter
Previous endoscopic
surgery

P3-10: Table 3. The aetiologies causing presentation with
recurrent stricture, and their incidence of occurrence following
previous urethroplasty, in 3,744 men.
Stricture aetiology

Previous urethroplasty

Hypospadias/previous treatment
Lichen sclerosis
Physical/iatrogenic trauma
Catheter
No identified cause
Previous endoscopic surgery

77.7%
24.1%
14.3%
12.5%
10.4%
6.7%

P3-10: Table 4. The sites of presentation with recurrent
urethral stricture following, one (1 op) or more than one
(>1op) previous urethroplasty, for lichen sclerosis associated
stricture disease or previous hypospadias repair.
Stricture site

Bulbar
Peno-bulbar
Penile
Meatus & Navicular fossa
Number of patients with
recurrence
Overall recurrent
stricture rate

lichen sclerosis previous
hypospadias
1 op

>1 op 1 op

>1 op

14.9%
3%
41.6%
40.5%
101

8%
12%
72%
8%
25

8.2%
3.8%
75.6%
12.4%
209

19.2% 4.9%

7.9%
5.5%
60.4%
26.2%
164

34.2% 43.5%

Incidence
Stricture

Fistula

39%
13.5%
12.9%

22.5%
1.9%
50%

10.2%

21.8%

7.8%
4.6%

1.9%
1.9%

Untreated
hypospadias

P3-10: Table 5. The percentage of 4,067 men presenting
in urinary retention, dependent upon stricture site, and the
percentage performing self-dilatation at referral.
Stricture site

100%

Cases Presentation Self-dilating
in retention

Bladder neck
34 32.3%
Bulbo-prostatic
196 72.5%
Bulbar
2,161 20.2%
Peno-bulbar
448 23.6%
Penile
784 14.7%
Meatus & Navicular fossa 444 7%

17.6%
3.1%
28%
33.9%
32.1%
38.1%

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