Urethroplasty Outcomes for Urethral Stricture Disease in Patients with Neurogenic Bladder or Bladder Dysfunction Requiring Clean Intermittent Catherization - Beyond the Abstract

Patients with neurogenic bladder or severe myogenic failure require safe bladder drainage. Often, these patients are managed with clean intermittent catheterization (CIC), however long-term CIC can result in significant urethral trauma, including the development of urethral stricture disease (USD). In our series, for example, 44% of men developed stricture following a traumatic CIC event. Endoscopic management with urethrotomy or dilation can facilitate early return to CIC. However, in severe cases of USD, management requires urinary diversion, catheterizable channel, permanent suprapubic tube (SPT), or urethroplasty. We present data on the safety and efficacy of urethroplasty in this population and offer thoughts on the ideal transition back to CIC following urethroplasty.

To that end, we pursued a multi-institutional series on the outcomes of urethral reconstruction for patients with USD who require CIC for bladder drainage secondary to neurogenic bladder (myogenic failure, spina bifida, and spinal cord injury). Patients with known USD using calibration as a management strategy were excluded.

Thirty-seven patients underwent urethroplasty in this series. Thirty-three patients (90%) demonstrated patency without a repeat procedure. The majority (32; 86%) returned to CIC for primary management, while others were able to spontaneously void and/or use condom catheters. Patients who underwent urethral rest with SPT (44%) and those who continued CIC up to the time of urethroplasty were both included without any change to the outcome. No patient with graft urethroplasty had a recurrence. Interestingly, 8 patients had a cystoscopic recurrence but had no challenge with CIC. Complications were rare (6; 16%) including 4 patients who required repeated surgery for recurrent stricture. No patients in this population required urinary diversion with a median follow-up of 3.1 years.

Urethroplasty is a viable, safe, and effective option to facilitate continued CIC. For appropriately selected and counseled patients, urinary diversion may be delayed or avoided by timely urethroplasty and continued CIC.

Written by: Jason L. Lui,1 Nathan M. Shaw,1 Andrew J. Cohen,2 Benjamin N. Breyer1

  1. Department of Urology, University of California San Francisco, San Francisco, CA, USA
  2. James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA

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