Author ' s Accepted Manuscript Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions

Purpose: Prior to urethral reconstruction, many stricture p atients undergo a variable period during which endoscopic treatments are emplo yed for recurrent obstructive symptoms. We evaluate the association between ureth roplasty delay, endoscopic treatments, and subsequent reconstructive outcomes. Materials and Methods: We reviewed men undergoing primary bulbar urethrop lasty from 2007-2014. Prior urethroplasty, penile and/or membranous strictures, and cases with incomplete data were excluded. Men were strati fied by urethroplasty delay of <5, 510, and >10 years from diagnosis. Results: A total of 278 primary bulbar urethroplasty cases with complete data were evaluated. Median time between stricture diagnosis and reconst ruction was 5 years (IQR 2-10). Patients underwent an average 0.9 (± 2.4) e ndoscopic procedures per year of delay. Relative to <5 and 5-10 years, delay >10 yea rs w s associated with more endoscopic treatments (median 1 vs 2 vs 5), repetit ive self-dilations (13% vs 14% vs 34%), strictures >2 cm (40% vs 39% vs 56%), and com plex reconstructive techniques (17% vs 17% vs 34%). Increasing number of endoscopi c treatments (OR 1.06; p=0.003) was independently associated with strictures >2 cm, which had worse 24-month stricturefree survival compared to shorter strictures (83% v s 96%; p=0.0003). Each consecutive DVIU was independently associated with risk of uret h oplasty failure (HR 1.19; p=0.02). M AN US CR IP T AC CE PT ED ACCEPTED MANUSCRIPT