Delineating Which Patient-Reported Symptoms are Associated with Satisfaction After Urethroplasty.

OBJECTIVE: To determine which patient-reported symptoms are associated with satisfaction after urethroplasty.

METHODS: From 2011-2018, patients were offered enrollment in a prospective study assessing patient-reported outcomes after urethroplasty. Outcomes were assessed pre-operatively and 6-months postoperatively including patient satisfaction, voiding function (IPSS), erectile function (IIEF-5) and ejaculatory function (ejaculatory component of brief sexual function inventory). Additionally, penile curvature/appearance, genitourinary pain, post-void dribbling, and standing voiding function were also evaluated using either 3 or 5 point Likert scales. Stricture recurrence was defined as the inability to easily pass a 16Fr flexible videocystoscope. Multivariable binary logistic regression was used to examine the associations between outcomes and patient satisfaction.

RESULTS: 387 patients completed the study with a mean age of 49.5 years and a mean stricture length of 4.5cm. Location was bulbar (59.4%), penile (19.6%), posterior (13.7%) and pan-urethral (7.2%). At 6-months, 96.1% of patients were stricture-free, 81.6% reported being satisfied with surgery and 8.0% were unsatisfied. On multivariable binary logistic regression, improvement in IPSS (O.R.1.1, 95%CI 1.1-1.2, p=0.04), new erectile dysfunction (O.R.0.5, 95%CI 0.2-0.9, p=0.04), new penile curvature (O.R. 0.4, 95%CI 0.2-0.9, p=0.03) and improved standing voiding function (O.R.1.3, 95%CI 1.1-1.5, p=0.004) were associated with patient satisfaction. Cystoscopic success (p=0.60), change in pain score (p=0.14), post-void dribbling (p=0.69), change in penile length (p=0.44) and ejaculatory dysfunction (p=0.51) were not.

CONCLUSION: Improved voiding function, patient-reported penile curvature, new erectile dysfunction and improved standing voiding are independently associated with patient satisfaction after urethroplasty and should be incorporated into any patient-centered approach to urethral stricture management.