Prior Endoscopic Treatment and Recurrence after Anterior Urethroplasty in Men with Urethral Stricture Disease: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.37287/ijghr.v8i6.2570Keywords:
anterior urethral stricture, direct vision internal urethrotomy, endoscopic treatment, recurrence, urethral dilation, urethroplastyAbstract
Endoscopic treatment is frequently performed before definitive urethroplasty in men with anterior urethral stricture disease. However, the association between prior endoscopic intervention and postoperative recurrence or failure after urethroplasty remains clinically important, particularly among patients who undergo repeated dilation or direct vision internal urethrotomy. This systematic review and meta-analysis aimed to evaluate the association between prior endoscopic treatment and recurrence or failure following anterior urethroplasty, including the potential effect of repeated prior endoscopic procedures. A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO. PubMed, Scopus, and ScienceDirect were searched from database inception without publication-year restrictions. A total of 2,619 records were identified, of which 15 observational studies published between 2003 and 2022 were ultimately included in the systematic review. Eligible studies included adult men with anterior urethral stricture disease who underwent urethroplasty and reported extractable data on prior endoscopic treatment and postoperative recurrence or failure. Methodological quality was assessed using the Newcastle–Ottawa Scale. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for dichotomous outcomes, while adjusted hazard ratios (HRs) were pooled separately using the generic inverse variance method. Fifteen observational studies comprising 4,515 patients were included. Prior endoscopic treatment was associated with a higher risk of recurrence or failure after urethroplasty than no prior endoscopic treatment or primary urethroplasty (OR 1.58, 95% CI 1.13–2.21; p = 0.008; I² = 0%). Time-to-event analyses similarly demonstrated an increased risk (HR 1.48, 95% CI 1.12–1.97; p = 0.006; I² = 58%). Repeated prior endoscopic procedures were associated with an approximately twofold higher risk of recurrence or failure (OR 2.06, 95% CI 1.30–3.28; p = 0.002; I² = 17%). Prior endoscopic treatment is associated with poorer outcomes following anterior urethroplasty, with a more pronounced risk among patients undergoing repeated endoscopic procedures. These findings support earlier referral for reconstructive evaluation in patients with recurrent anterior urethral stricture disease who are unlikely to benefit from further endoscopic management.
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