Viers BR, et al. - This paper resolved to illustrate the stricture characteristics, complications and treatment outcomes among elderly men undergoing urethral reconstruction. It was deduced that urethroplasty was safe and effective in maximum elderly men. The outcomes could be optimized via early reconstructive intervention with anastomotic urethroplasty or urethrostomy techniques. The occurrence of voiding dysfunction and prostatic obstruction were commonly noted in the study cohort. Hence, it ought to be pursued as clinically indicated.

Methods

• This research carried out a retrospective appraisal of urethroplasty cases and outcomes by a single surgeon, from 2007-2014.
• Stratification of men was done in terms of the decade of life at the time of surgery (<50, 50-59, 60-69, ≥70 years).
• The exclusion criteria were patients presenting with a history of hypospadias.

Results

• 184 (36%) were ≥60 years, among 514 urethroplasty procedures.
• When stratified by decade of life, elderly men exhibited a greater likelihood of presenting with a history of radiation therapy (0% vs 5% vs 19% vs 50%; p<0.0001) and experience treatment failure (6% vs 16% vs 20% vs 26%; p<0.0001) during follow-up (median 63 months).
• The estimated 60-month stricture recurrence-free survival decreased alongside the increase in age at time of urethroplasty (94% vs 89% vs 78% vs 74%; p<0.0001).
• In patients ≥60, success rates of anastomotic, substitution, and urethrostomy techniques were 80%, 65%, and 88%; anastomotic urethroplasty success improved after excluding those with prior radiation.
• Following surgery, elderly were more susceptible for voiding dysfunction and <90 day Clavien ≥3 complications requiring endoscopic intervention.
• An independent correlation was observed between advancing age per decade beyond 50 years with the risk of urethroplasty failure - 50-59 (HR 2.39; p=0.02), 60-69 (HR 2.80; p=0.009) and ≥70 (HR 3.43; p=0.003), noted by multivariable analysis.