Factors Influencing the Treatment Outcomes of Patients Undergoing Urethroplasty for Urethral Stricture at Muhimbili National Hospital

Factors Influencing the Treatment Outcomes of Patients Undergoing Urethroplasty for Urethral Stricture at Muhimbili National Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Influencing the Treatment Outcomes of Patients Undergoing Urethroplasty for Urethral Stricture at Muhimbili National Hospital Naomi Herbert Mtafu, Gabriel Francis Mtaturu, Aboud Muhsin, Amini Mitamo Alexandre, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5347572/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Urethral stricture disease poses a substantial challenge in Sub-Saharan Africa, where the prevalence is notably high. This condition predominantly impacts men, and the underlying causes in the region are diverse and varied. There is a significant research gap in understanding the patient-related factors that contribute to the outcomes of urethroplasty for urethral strictures at Muhimbili National Hospital. Objectives: To determine the factors influencing treatment outcomes among patients undergoing urethroplasty for urethral stricture at Muhimbili National Hospital. Methodology: This cross-sectional analytical study was carried out at Muhimbili National Hospital. Through convenient sampling, data from the hospital’s patient database, specifically from patients aged 10 years and above, were extracted using a structured abstraction form. Patient information, clinical findings, treatment offered and treatment outcomes were collected. The collected data were analyzed using SPSS 23. Results: This study examined 126 patients with urethral stricture who underwent urethroplasty at MNH between January 2020 and December 2022. The mean age was 51 years, with the bulbar urethra being the most common stricture site (54%) and trauma the leading cause (44.4%). The success rate of urethroplasty was 85.7%, with a 15.9% complication rate. Early complications included surgical site infections (54.5%), painful scrotum (36.4%), and wound dehiscence (9.1%). Late complications predominantly consisted of irritative lower urinary tract symptoms (83.3%), stress incontinence (5.6%), and erectile dysfunction (11.1%). Younger patients (<60 years) and those with infectious etiologies had significantly higher success rates. The type of stricture, length of stricture, surgical approach, and catheter type did not significantly impact outcomes. Conclusion: Urethroplasty had a high success rate of 85.7%, particularly in younger patients and those with infectious etiologies. Trauma was identified as the most common cause of urethral strictures, primarily affecting the bulbar urethra. Postoperative complications, both early and late, were observed, indicating the need for careful postoperative monitoring. Factors such as stricture level, length, surgical approach, and catheter type did not significantly impact the success of urethroplasty. Influencing factors treatment outcomes urethroplasty Figures Figure 1 Introduction Urethral stricture disease (USD), is a condition characterized by constriction or narrowing of the urethra. The presence of USD can lead to urinary retention, blockage of the bladder outlet, irritation of the genital-urinary system, recurrent urinary tract infections, and impaired ejaculatory function. These, significantly impact an individual’s quality of life. [ 2 ]. The causes of urethral stricture can be classified as iatrogenic, infectious, or traumatic, with iatrogenic strictures being the most prevalent, accounting for 33% of cases. Traumatic causes constitute 19% of cases, and infectious causes contribute to approximately 15% of urethral strictures [ 3 ]. In the world, urethral stricture is estimated to have a prevalence of 229–627/100,000 [ 7 ]. Urethral stricture disease poses a substantial challenge in the Sub-Saharan African region, indicating a notable burden on healthcare systems and patients in the area. Although the type and breadth of treatment vary amongst subregions, urethroplasty has gained popularity [ 5 ]. From the study done by Mugalo et al from Moi Hospital in East Africa, the etiology of cases involving trauma were split almost evenly between iatrogenic (28%) and external trauma (25%) [ 9 ]. In general, the treatment of urethral strictures can be categorized into two main approaches: transurethral methods (such as dilation and internal urethrotomy) and open surgical procedures (including excision and anastomosis, augmented urethroplasty, and perineal urethrostomy). Urethroplasty is the gold standard for the treatment of urethral stricture, and despite its good success rate, it can cause minor or major complications that can occur either early or late. In their study on the complications of urethroplasty, Al Qudah and Santucci attempted to explain these complications in detail [ 12 ]. Several factors can influence the outcome of urethroplasty, including the length, location, and complexity of the urethral stricture [ 14 ]. METHODOLOGY Study Design: This was a cross-sectional study in which data were retrospectively collected from patients undergoing urethroplasty for urethral stricture at MNH between January 2020 and December 2022. Study Population: All male patients aged 10 years and above diagnosed with urethral stricture and underwent urethroplasty at the Urology department in MNH. Inclusion Criteria: All patient records that met the standard of variable requirements to be assessed were included in the study. Exclusion Criteria: Patients with congenital urethral anomalies (e.g. those with urethral stricture due to hypospadias repair) and records with incomplete data were excluded from this study. Variables: Patient Demographics, clinical factors, surgical factors, and preoperative care were considered as independent variables. The outcomes included urethral function and complications, and the factors contributing to the treatment outcomes were considered as depended variables. Data Collection: The data on patients who underwent urethroplasty was obtained from patient records extracted from patients’ database, using a structured tool. The data collected included factors influencing the treatment outcomes of patients who underwent urethroplasty as explained in various sections above. The patient’s profile included age, symptom duration, days of admission and history of smoking and the comorbidities included diabetes, lichen sclerosus, hypertension and COPD. The level of the stricture and the type of reconstruction were recorded in data collection tool. Ethical Clearance: Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences Institutional Review Board (Ref. No. DA.). Permission for data collection was granted by the MNH research and consultancy unit. Statistical Analysis: Data were analyzed using SPSS software version 23. Descriptive statistical analysis was employed to summarize the patients’ profiles. The chi-square and Fisher’s exact test were applied to examine associations between surgical outcomes and categorical factors such as surgical technique. Logistic regression was used to assess the relationship between the variables (such as patient demographics, clinical factors, surgical techniques) and a binary outcome (successful outcome or recurrence). The degree of association between the variables were determined using adjusted odds ratios and their corresponding 95% confidence intervals. A p-value ≤ 0.05 was considered to indicate a statistically significance between the variables. RESULTS Profile of patients with urethral stricture Between January 2020 and December 2022, a total of 126 patients who met the inclusion criteria among those who underwent urethroplasty were included. The youngest patient was 14 years old, while the oldest patient was 97-year-old. The mean age ± SD was 51 ± 20 years, indicating that a broad age range was affected by urethral stricture. The bulbar urethra was the most common level of stricture (38 patients, 54.0%), followed by the peno-bulbar (39 patients, 31.0%), penile (14 patients, 11.1%), and bulbo-membranous (5 patients, 4.0%) urethras. There were no strictures involving the prostatic urethra. Trauma was the most common aetiology of stricture, with 56 cases (44.4%), followed by iatrogenic causes (22 cases, 17.5%), infectious causes (19 cases, 15.1%), and unknown causes (29 cases, 23.0%). Comorbidities were observed in some patients, with 9 (21.4%) having diabetes, 30 (71.4%) having hypertension, and 3 (7.2%) having non-urological malignancies. Regarding the length of the stricture, 29 patients (23%) had long segment (>2.5 cm) and 97 patients (77%) had short segment (≤2.5 cm). Among the urethroplasties, 50 (39.7%) BMG and 76 (60.3%) EPA procedures were performed, indicating a preference for EPA over BMG. This trend might be attributed to the predominance of younger participants in the research cohort, who constituted the majority among patients with strictures, and the greater frequency of trauma as the primary cause of stricture, particularly at the level of the bulbar urethra. Regarding the urethral catheter used, 52 (41.3%) were latex catheters, and 74 (58.7%) were silicone catheters. Urethroplasty Outcomes The results indicate that 85.7% of the urethroplasty procedures were successful, while 14.3% resulted in failure or recurrence. Complications were observed in 15.9% of patients, with early complications including surgical site infection (SSI) in 54.5%, painful scrotum in 36.4%, and wound dehiscence in 9.1%. Late complications predominantly consisted of Irritative ± obstructive Lower Urinary Tract Symptoms (LUTS) in 83.3% of patients, with a smaller percentage experiencing stress incontinence (5.6%) and erectile dysfunction (11.1%). These findings suggest that while the majority of urethroplasty surgeries were successful, a notable portion of patients experienced postoperative complications, emphasizing the importance of careful monitoring and management of patients undergoing such procedures. See Table 2 below. Factors influencing success among patients undergone urethroplasty Age was classified into two groups: younger individuals under 60 years old and older individuals aged 60 years and above, referring to methodologies used in comparable prior studies [13]. Table 3 presents a chi-square test analysis of factors associated with the success of urethroplasty. The success rates vary significantly with age; younger patients (<60 years) have a higher success rate compared to older patients (≥60 years) with a statistically significant p-value of 0.001. Etiologies of the condition do not show significant differences in success rates, with traumatic, iatrogenic, infectious, and unknown causes all having varying but non-significant success rates (p=0.138). The level of stricture (penile, peno-bulbar, bulbar-urethra, bulbo-membranous) also does not significantly affect success rates (p=0.578). Similarly, the length of the stricture (short segment ≤2.5 cm vs. long segment >2.5 cm) shows no significant impact on success (p=0.763). The surgical approach, whether BMG or EPA, does not significantly influence success rates (p=0.795). Lastly, the type of catheter used (latex vs. silicone) also shows no significant difference in success rates (p=0.447). The findings from the multivariable logistic regression analysis of factors influencing the success rate among patients undergoing urethroplasty revealed several significant associations. Younger patients (<60 years) have significantly higher success rates (94.9%) compared to older patients (70.8%), with COR 0.13 and AOR 0.09. Among etiologies, infectious causes have higher odds of success (73.7%) compared to unknown causes, with COR 10.0 and AOR 13.12. Traumatic and iatrogenic causes do not show significant differences. The level and length of the stricture, surgical approach, and catheter type do not significantly impact success rates. Notably, younger age and infectious etiology are associated with better treatment outcomes. See table 4 below. DISCUSSION The American Urological Association released updated guidelines in 2016 for the treatment of urethral stricture disease. These guidelines outline various approaches to managing urethral strictures, such as end-to-end primary anastomosis (EPA) and augmented urethroplasty, typically using buccal mucosa graft (BMG). The selection of the appropriate technique depends on factors such as the specific location within the urethra affected by the stricture and the length of the stricture itself [7]. The current study investigated the factors influencing the treatment outcomes in patients undergoing urethroplasty for urethral stricture at MNH. The findings of this study are discussed in this chapter. Patients Characteristics Until now, the majority of urethroplasty studies have been characterized by relatively small sample sizes and considerable diversity in patient populations, which has restricted the possibility of conducting subgroup analyses based on particular demographic and clinical features [13,14]. However, the present study faced challenges in achieving a large sample size. Urethral stricture can occur across a wide age range, but there is a notable difference in prevalence between younger and older individuals. This study demonstrated this finding and is in line with studies conducted by Levy et al in Italy, Tinaut-Ranera in Spain and Ofoha et al in Nigeria [13,14,34]. In younger patients, trauma tends to be a more common aetiology, possibly due to activities associated with higher risk, such as sports or motor traffic crash. The findings of this study indicate that trauma is the predominant cause of urethral stricture in younger individuals, accounting for 73.2% of cases. On the other hand, older patients may develop urethral stricture due to a range of factors, including age-related alterations in tissue elasticity, urinary tract infections, or complications arising from medical procedures. Notably, iatrogenic causes were responsible for 70.0% of strictures in older patients in our study. This observation suggested that urinary problems and hospitalizations requiring urethral catheterization and instrumentation may contribute significantly to the development of urethral stricture in this age group. These findings are consistent with those reported in studies by Kimu et al., Musau et al., and El et al [9,11,33]. Outcomes of BMG and EPA urethroplasty Conventionally, the primary approach for treating urethral stricture involves urethral dilatation and/or direct vision internal urethrotomy (DIVU) or Sachse procedures. These methods are preferred due to their simplicity and minimal morbidity. However, despite initial symptom improvement, urethral dilatation or urethrotomy often results in a high rate of recurrence, with endoscopic procedures frequently demonstrating low efficacy. Falavolti et al. highlighted this issue [25]. The current section discusses the findings of various urethroplasty techniques and their respective outcomes. Anastomotic urethroplasty and graft urethroplasty are the prevailing techniques, and exhibit comparable long-term success rates [5,12,13,34]. Despite the increased incidence of urethral strictures with advancing age, there remains a dearth of literature on urethroplasties in elderly patients. In this study, a majority of urethroplasties were performed in younger patients (61.9%) compared to elderly patients (38.9%), a trend consistent with findings from studies by Erickson et al [35]. and Falavolti et al [25]. The contemporary definition of success encompasses both anatomical (where a flexible cystoscope can traverse the reconstructed urethra without difficulty) and functional (with patient-reported amelioration of voiding symptoms and urinary quality of life) criteria [35]. The success rate of urethroplasty in this study was 85.7%. Corresponding studies have reported success rates ranging from approximately 90%, as delineated by Falavolti et al [25]. and Wong et al [36]., with simpler procedures demonstrating higher success rates than complex repairs. Buccal mucosa grafts are favoured due to their ease of procurement, greater availability, resistance to infection, and favourable tissue characteristics [37]. Numerous studies have indicated superior success rates with buccal mucosa grafts compared to end-to-end urethroplasty, even in managing short bulbar strictures [25]. Interestingly, the present study revealed a slightly greater success rate in EPA than in BMG urethroplasty, consistent with the findings from Levy et al [13]., who reported that EPA was superior to BMG for achieving 3-month anatomic success after adjusting for other factors. The outcome of this study could be explained by the preference of surgeons preferring EPA over BMG in MNH. Overall, 15.9% of patients in this study experienced complications, some of whom experienced early complications, some late complications and some experienced both. Findings from this study were slightly lower compared than those of Al-Qudah et al, who reported complication rates of 21% for anterior anastomotic urethroplasty and 40% for fasciocutaneous onlay urethroplasty [12,36]. Similarly, Andrich et al [38]. Reported a significantly greater complication rate after fasciocutaneous urethroplasty (33%) than after anastomotic urethroplasty (7%). Surgical site infection has emerged as the most prevalent early complication, a topic that has been underexplored in recent literature. The recurrence of stricture manifested as LUTS in patients undergoing both EPA and BMG procedures, albeit more pronounced in BMG patients. Furthermore, erectile dysfunction was reported in 2 patients who underwent EPA, consistent with findings from Al-Qudah et al [12]. Factors influencing urethroplasty outcomes While previous studies have explored factors predicting postoperative outcomes of urethroplasty, such as success, complications, and recurrence in patients with urethral strictures, these studies frequently have limited scope, focusing solely on specific stricture locations (e.g., bulbar strictures) or individual urethroplasty techniques. Given the size and diversity of the patient, this study could incorporate variables such as stricture length and location, among others to study urethroplasty outcomes. To explore potential predictors that may impact the outcomes of urethroplasty, factors including age, aetiology, level and length of stricture, surgical technique, and type of catheter employed were considered. There is conflicting evidence regarding the successful outcomes of urethroplasty in the elderly population [31,40,41]. This study revealed that younger age was significantly associated with successful urethroplasty, while older age was associated with lower odds of success. This finding aligns with findings from previous studies investigating age in relation to urethroplasty. For instance, Schwentner et al [40]. observed a greater urethroplasty failure rate in older patients, although the study did not account for variations in comorbidities between groups. Conversely, in a series of 604 urethroplasties conducted in a tertiary referral center, factors such as stricture length, lichen sclerosus, iatrogenic and infectious aetiology, rather than age over 50 years, were independently linked to stricture recurrence [31]. Similarly, Santucci et al [39] demonstrated in a multicentric series involving different urethroplasty techniques that there was a comparable incidence of postoperative complications and treatment failure in patients older than 65 years compared to their younger counterparts (<65 years old). Age had a notable impact on outcomes, particularly concerning success rates and complications. Interestingly, despite the older group exhibiting significantly greater rates of comorbidities, the outcomes remained statistically similar. Specifically, hypertension was notably more prevalent among older men; however, it did not emerge as a significant predictor of either success or complication rates. Although many 60-year-old men may exhibit functional and biological characteristics that suggest that they are younger than their chronological age, it is a well-established epidemiological fact that the prevalence of comorbidities tends to increase with advancing age. In terms of surgical approach, EPA initially appeared to outperform BMG, but it did not emerge as a statistically significant predictor for success when other factors were controlled (p=0.656). However, it is important to note that this comparison was not the primary focus of the study but rather a factor that was controlled for as a confounder. Notably, stricture length did not emerge as a predictor of functional success, potentially due to the relatively small sample size. LIMITATIONS, CONCLUSION AND RECOMMENDATIONS Limitations The limitations of this study stem from its single-center design and retrospective nature, lack of objective assessment tool like uroflowmetry to determine the success or failure. Although efforts were made to collect comprehensive data from patient files, some information were missing or incomplete. Conclusion This study evaluated 126 patients who underwent urethroplasty, revealed diverse demographics affected by urethral stricture, with trauma being the leading cause. The bulbar urethra was the most commonly affected site, and comorbidities such as diabetes and hypertension were observed. A preference for EPA over BMG procedures was noted, potentially influenced by patient age and aetiology, particularly trauma at the bulbar urethra level. The complication rates were notable, emphasizing the importance of thorough postoperative care. Additionally, younger age and infectious aetiology were associated with higher success rates of urethroplasty, while iatrogenic aetiology was correlated with lower success rates. Overall, these findings emphasize the need for personalized management approaches in urethroplasty patients, considering individual factors such as age and aetiology to optimize outcomes and minimize complications. Recommendations Based on the findings of this research, it is recommended that urethroplasty be considered as a viable option for treating urethral strictures, even in older patients. Further studies should aim to investigate the impact of specific comorbidities, such as hypertension, on the outcomes of urethroplasty in older patients. Additionally, longitudinal studies with larger sample sizes are needed to validate the findings of this research and explore the long-term success rates and complications associated with different urethroplasty techniques. Furthermore, research focusing on the optimal management strategies for urethral strictures in elderly populations, considering factors such as age-related changes in tissue elasticity and vascular supply, would be beneficial for informing clinical practice. Abbreviations BMI Body Mass Index BMG Buccal Mucosa Grafting DVIU Direct Vision Internal Urethrotomy EPA Excision and Primary Anastomosis GU Genitourinary LUTS Lower Urinary Tract Symptoms MCS Microscopic Culture and Sensitivity MNH Muhimbili National Hospital MUHAS Muhimbili University of Health and Allied Science MUS Male urethral stricture NLR Neutrophil to Lymphocyte Ratio TUR Transurethral resection UTI Urinary Tract Infection USD Urethral stricture disease SPSS Statistical Package for the Social Sciences Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board and was granted ethical approval (Ref. No. DA.282/298/01.C/1964). A waiver for consent was issued by MUHAS since the principal investigator was solely working on medical records. This research adheres to the ethical guidelines and complies with all applicable local and international regulations. Consent for publication Permission for publication was obtained from the institutions involved in this study. The confidentiality and privacy of individuals involved in this research have been rigorously maintained, and no details that could disclose patient’s identity are presented in the manuscript. Funding The research conducted herein was not funded by any external grants or financial support. All work presented in this study was carried out independently, and the authors did not receive any financial assistance from individuals, organizations, or institutions. Author Contribution N.H.M-conception and design of the study, data acquisition and analysis, interpretation of results, drafting and revising the manuscript.G.F.M-conceptualization and design of the study, overseeing data collection, performing statistical analysis, interpreting results, and contributing significantly to manuscript writing and revision as a co-supervisor.A.M-overall study design, supervised data collection and analysis, interpreted results, and made substantial contributions to the drafting and critical revision of the manuscript as the supervisor.A.M.A & J.K.M-participated in analysis, and interpretation. Additionally, they contributed to drafting and critically reviewing the manuscript for intellectual content.A.H.M,O.V.N & C.A.M-contributed to the study design, data acquisition and interpretation, and provided valuable insights during manuscript drafting and revision. All authors have read and approved the final manuscript. 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Tinaut-Ranera J, Arrabal-Polo MÁ, Merino-Salas S, Nogueras-Ocaña M, López-León VM, Palao-Yago F, et al. Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty. J Can Urol Assoc. 2014;8(1–2):1–4. Erickson BA, Ghareeb GM. Definition of Successful Treatment and Optimal Follow-up after Urethral Reconstruction for Urethral Stricture Disease. Urol Clin North Am. 2017 Feb;44(1):1–9. Wong SSW, Aboumarzouk OM, Narahari R, O’Riordan A, Pickard R. Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men. Cochrane database Syst Rev. 2012 Dec;12:CD006934. Bullock TL, Brandes SB. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol. 2007 Feb;177(2):685–90. Andrich DE, Leach CJ, Mundy AR. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int. 2001 Sep;88(4):385–9. Gallegos MA, Santucci RA. Advances in urethral stricture management. F1000Research. 2016;5:2913. Schwentner C, Seibold J, Colleselli D, Alloussi SH, Schilling D, Sievert KD, et al. Dorsal onlay skin graft urethroplasty in patients older than 65 years. Urology. 2010 Aug;76(2):465–70. Heyns CF, van der Merwe J, Basson J, van der Merwe A. Treatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty. S Afr J Surg. 2012 Jul;50(3):82–7. Tables Table 1 : Characteristics of patients undergoing urethroplasty, N=126 Variables Frequency Percent Age in years (mean ± SD) 51 ± 20 Length of stricture Long segment (>2.5 cm) 29 23 Short segment (≤2.5 cm) 97 77 Stricture level Penile 14 11.1 Peno-bulbar 39 31.0 Bulbar-urethra 38 54.0 Bulbo-membranous 5 4.0 Aetiology of stricture Traumatic 56 44.4 Iatrogenic 22 17.5 Infectious 19 15.1 Unknown 29 23.0 Comorbidities Diabetes 9 21.4 Hypertension 30 71.4 Non-urological malignancy 3 7.2 Surgery type BMG 50 39.7 EPA 76 60.3 Urethral catheter type Latex 52 41.3 Silicone 74 58.7 Table 2: Outcome of urethroplasty among patients undergoing BMG and EPA Variables Frequency Percent Surgical outcome Success 108 85.7 Fail/recurred 18 14.3 Complication rate Yes 20 15.9 No 106 84.1 Early complications SSI 6 54.5 Painful scrotum 4 36.4 Wound dehiscence 1 9.1 Late complications Irritative ± Obstructive LUTS 15 83.3 Stress incontinence 1 5.6 Erectile dysfunction 2 11.1 LUTS; Lower urinary tract symptoms SSI; Surgical site infection Table 3: Chi-square test for factors associated with success of urethroplasty Variable Success p-value Yes No Age during treatment (years) 0.001 Young (<60) 74 (94.9) 4 (5.1) Old (≥ 60) 34 (70.8) 14 (29.2) Etiologies 0.138 Traumatic 47 (83.9) 9 (16.1) Iatrogenic 19 (86.4) 3 (13.6) Infectious 14 (73.7) 5 (26.3) Unknown 28 (96.6) 1 (3.4) Level of stricture 0.578 Penile 11 (78.6) 3 (24.1) Peno-bulbar 35 (89.7) 4 (10.3) Bulbar-urethra 58 (85.3) 10 (14.7) Bulbo-membranous 4 (80.0) 1 (20.0) Length of stricture (cm) 0.763 Short segment ≤2.5 82 (84.5) 15 (15.5) Long segment >2.5 26 (89.7) 3 (10.3) Surgical approach 0.795 BMG 42 (84.0) 8 (16.0) EPA 66 (86.8) 10 (13.2) Catheter type 0.447 Latex 43 (82.7) 9 (17.3) Silicone 65 (87.8) 9 (12.2) Table 4: Multivariable logistic regression of factors affecting urethroplasty success rate Variable Bivariate Multivariable COR (95%Cl) P- value AOR (95%Cl) P- value Age during treatment (years) Young (<60) 0.13 (0.04 – 0.43) 0.001 0.09 (0.03 – 0.33) <0.001 Old (≥ 60) Ref Ref Etiologies Traumatic 5.3 (0.65 – 44.60) 0.120 8.14 (0.89 – 73.79) 0.062 Iatrogenic 4.42 (0.43 – 45.75) 0.213 2.38 (0.22 – 26.02) 0.477 Infectious 10.0 (1.06 – 94.01) 0.044 13.12 (1.23 – 139.67) 0.033 Unknown Ref Ref Level of stricture Penile 1.09 (0.08 – 13.78) 0.946 Peno-bulbar 0.46 (0.04 – 5.16) 0.527 Bulbar-urethra 0.70 (0.07 – 6.82) 0.751 Bulbo-membranous Ref Length of stricture (cm) Short segment ≤2.5 1.5 (0.43 – 5.90) 0.492 Long segment >2.5 Ref Surgical approach BMG 1.26 (0.46 – 3.44) 0.656 EPA Ref Catheter type Latex 1.51 (0.55 – 4.11) 0.419 Silicone Ref 1. AOR: Adjusted Odds Ratio 2. COR: Crude Odds Ratio 3. Cl: Confidence limit 4. Bold p-value means significant at p < 0.05 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5347572","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":374616998,"identity":"ca59a3a0-445a-4abd-9326-06d1471b7a30","order_by":0,"name":"Naomi Herbert Mtafu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYPCCAwwMEiC6AojZGRgYG4jWcuAMAwMPM0laDrYRocWc/fDRzbxtd+TMZzcf+/xxnk3ifmbmgw9nMNjJ6eLQZ9mTlnabt+2ZscydY8kzDm5LS+xhZks23MCQbGx2ALsWgwM5ZkAthxNnSOQYMxzcdhiohcdM8gHDgcRtuLScfwPWUj9DIv8zw8E5xGi5AbElQUIih5nhYANUywa8Wp6l3Zxz7rDhDJljxgxnjqUZ9xwG+mWGAR6/nE8+duNN2WF5CenmxwwVNTay7e3NBx/2VNjJ4dICAky8bJhG4VYOAow//uBXMApGwSgYBSMcAADeP2Rpwm961wAAAABJRU5ErkJggg==","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Naomi","middleName":"Herbert","lastName":"Mtafu","suffix":""},{"id":374616999,"identity":"935b2f80-505a-4d52-87d9-5ff5fd492a87","order_by":1,"name":"Gabriel Francis Mtaturu","email":"","orcid":"","institution":"Muhimbili National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gabriel","middleName":"Francis","lastName":"Mtaturu","suffix":""},{"id":374617000,"identity":"2600c586-cf36-4986-a8fd-c42c308e3e9f","order_by":2,"name":"Aboud Muhsin","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Aboud","middleName":"","lastName":"Muhsin","suffix":""},{"id":374617001,"identity":"03560bc6-d6b5-48b8-8dfe-91db18556050","order_by":3,"name":"Amini Mitamo Alexandre","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Amini","middleName":"Mitamo","lastName":"Alexandre","suffix":""},{"id":374617002,"identity":"0dfcd79f-ae5b-42a7-b2f8-2ecb74699e22","order_by":4,"name":"Joachim Kulwa Mhaya","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Joachim","middleName":"Kulwa","lastName":"Mhaya","suffix":""},{"id":374617003,"identity":"4253c7e6-6f6a-4cdb-a668-03fd17a1da1b","order_by":5,"name":"Ally Hamis Mwanga","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ally","middleName":"Hamis","lastName":"Mwanga","suffix":""},{"id":374617004,"identity":"7963a607-bae9-499c-89cd-b36cdd9391da","order_by":6,"name":"Obadia Venance Nyongole","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Obadia","middleName":"Venance","lastName":"Nyongole","suffix":""},{"id":374617005,"identity":"90dd2fc4-539b-4f39-892d-0cdbf12c135b","order_by":7,"name":"Charles A. Mkony","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"A.","lastName":"Mkony","suffix":""}],"badges":[],"createdAt":"2024-10-28 13:38:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5347572/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5347572/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70405172,"identity":"8a9c88f4-671a-4f64-a856-316569b89bde","added_by":"auto","created_at":"2024-12-02 23:08:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35770,"visible":true,"origin":"","legend":"\u003cp\u003eA pie chart demonstrating late complications among patients undergoing urethroplasty\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5347572/v1/6f9363a390242b3f157d4f8a.png"},{"id":73565625,"identity":"00b75ed5-7adf-46cd-a05a-a4d58055a5ac","added_by":"auto","created_at":"2025-01-11 14:08:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1044924,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5347572/v1/926322f8-7306-428c-a8cf-67d1cad42f56.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors Influencing the Treatment Outcomes of Patients Undergoing Urethroplasty for Urethral Stricture at Muhimbili National Hospital\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrethral stricture disease (USD), is a condition characterized by constriction or narrowing of the urethra. The presence of USD can lead to urinary retention, blockage of the bladder outlet, irritation of the genital-urinary system, recurrent urinary tract infections, and impaired ejaculatory function. These, significantly impact an individual\u0026rsquo;s quality of life. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe causes of urethral stricture can be classified as iatrogenic, infectious, or traumatic, with iatrogenic strictures being the most prevalent, accounting for 33% of cases. Traumatic causes constitute 19% of cases, and infectious causes contribute to approximately 15% of urethral strictures [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the world, urethral stricture is estimated to have a prevalence of 229\u0026ndash;627/100,000 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Urethral stricture disease poses a substantial challenge in the Sub-Saharan African region, indicating a notable burden on healthcare systems and patients in the area. Although the type and breadth of treatment vary amongst subregions, urethroplasty has gained popularity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. From the study done by Mugalo et al from Moi Hospital in East Africa, the etiology of cases involving trauma were split almost evenly between iatrogenic (28%) and external trauma (25%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn general, the treatment of urethral strictures can be categorized into two main approaches: transurethral methods (such as dilation and internal urethrotomy) and open surgical procedures (including excision and anastomosis, augmented urethroplasty, and perineal urethrostomy).\u003c/p\u003e \u003cp\u003eUrethroplasty is the gold standard for the treatment of urethral stricture, and despite its good success rate, it can cause minor or major complications that can occur either early or late. In their study on the complications of urethroplasty, Al Qudah and Santucci attempted to explain these complications in detail [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Several factors can influence the outcome of urethroplasty, including the length, location, and complexity of the urethral stricture [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003e\u003cstrong\u003eStudy Design:\u003c/strong\u003e This was a cross-sectional study in which data were retrospectively collected from patients undergoing urethroplasty for urethral stricture at MNH between January 2020 and December 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population:\u003c/strong\u003e All male patients aged 10 years and above diagnosed with urethral stricture and underwent urethroplasty at the Urology department in MNH.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e All patient records that met the standard of variable requirements to be assessed were included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e Patients with congenital urethral anomalies (e.g. those with urethral stricture due to hypospadias repair) and records with incomplete data were excluded from this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables:\u003c/strong\u003e Patient Demographics, clinical factors, surgical factors, and preoperative care were considered as independent variables. The outcomes included urethral function and complications, and the factors contributing to the treatment outcomes were considered as depended variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection:\u0026nbsp;\u003c/strong\u003eThe data on patients who underwent urethroplasty was obtained from patient records extracted from patients\u0026rsquo; database,\u0026nbsp;using a structured tool.\u0026nbsp;The data collected included factors influencing the treatment outcomes of patients who underwent urethroplasty as explained in various sections above. The patient\u0026rsquo;s profile included age, symptom duration, days of admission and history of smoking and the comorbidities included diabetes, lichen sclerosus, hypertension and COPD. The level of the stricture and the type of reconstruction were recorded in data collection tool.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Clearance:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Muhimbili University of Health and Allied Sciences Institutional Review Board (Ref. No. DA.). Permission for data collection was granted by the MNH research and consultancy unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eData were analyzed using SPSS software version 23. Descriptive statistical analysis was employed to summarize the patients\u0026rsquo; profiles. The chi-square and Fisher\u0026rsquo;s exact test were applied to examine associations between surgical outcomes and categorical factors such as surgical technique. Logistic regression was used to assess the relationship between the variables (such as patient demographics, clinical factors, surgical techniques) and a binary outcome (successful outcome or recurrence). The degree of association between the variables were determined using adjusted odds ratios and their corresponding 95% confidence intervals. A p-value \u0026le; 0.05 was considered to indicate a statistically significance between the variables.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003eProfile of patients with urethral stricture\u003c/h2\u003e\n\u003cp\u003eBetween January 2020 and December 2022, a total of 126 patients who met the inclusion criteria among those who underwent urethroplasty were included. The youngest patient was 14 years old, while the oldest patient was 97-year-old. The mean age \u0026plusmn; SD was 51 \u0026plusmn; 20 years, indicating that a broad age range was affected by urethral stricture. The bulbar urethra was the most common level of stricture (38 patients, 54.0%), followed by the peno-bulbar (39 patients, 31.0%), penile (14 patients, 11.1%), and bulbo-membranous (5 patients, 4.0%) urethras. There were no strictures involving the prostatic urethra.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTrauma was the most common aetiology of stricture, with 56 cases (44.4%), followed by iatrogenic causes (22 cases, 17.5%), infectious causes (19 cases, 15.1%), and unknown causes (29 cases, 23.0%). Comorbidities were observed in some patients, with 9 (21.4%) having diabetes, 30 (71.4%) having hypertension, and 3 (7.2%) having non-urological malignancies. Regarding the length of the stricture, 29 patients (23%) had long segment (\u0026gt;2.5 cm) and 97 patients (77%) had short segment (\u0026le;2.5 cm). Among the urethroplasties, 50 (39.7%) BMG and 76 (60.3%) EPA procedures were performed, indicating a preference for EPA over BMG. This trend might be attributed to the predominance of younger participants in the research cohort, who constituted the majority among patients with strictures, and the greater frequency of trauma as the primary cause of stricture, particularly at the level of the bulbar urethra. Regarding the urethral catheter used, 52 (41.3%) were latex catheters, and 74 (58.7%) were silicone catheters.\u003c/p\u003e\n\u003ch2\u003eUrethroplasty Outcomes\u003c/h2\u003e\n\u003cp\u003eThe results indicate that 85.7% of the urethroplasty procedures were successful, while 14.3% resulted in failure or recurrence. Complications were observed in 15.9% of patients, with early complications including surgical site infection (SSI) in 54.5%, painful scrotum in 36.4%, and wound dehiscence in 9.1%. Late complications predominantly consisted of Irritative \u0026plusmn; obstructive Lower Urinary Tract Symptoms (LUTS) in 83.3% of patients, with a smaller percentage experiencing stress incontinence (5.6%) and erectile dysfunction (11.1%). These findings suggest that while the majority of urethroplasty surgeries were successful, a notable portion of patients experienced postoperative complications, emphasizing the importance of careful monitoring and management of patients undergoing such procedures. See Table 2 below.\u003c/p\u003e\n\u003ch2\u003eFactors influencing success among patients undergone urethroplasty\u003c/h2\u003e\n\u003cp\u003eAge was classified into two groups: younger individuals under 60 years old and older individuals aged 60 years and above, referring to methodologies used in comparable prior studies\u0026nbsp;[13].\u003c/p\u003e\n\u003cp\u003eTable 3 presents a chi-square test analysis of factors associated with the success of urethroplasty. The success rates vary significantly with age; younger patients (\u0026lt;60 years) have a higher success rate compared to older patients (\u0026ge;60 years) with a statistically significant p-value of 0.001. Etiologies of the condition do not show significant differences in success rates, with traumatic, iatrogenic, infectious, and unknown causes all having varying but non-significant success rates (p=0.138). The level of stricture (penile, peno-bulbar, bulbar-urethra, bulbo-membranous) also does not significantly affect success rates (p=0.578). Similarly, the length of the stricture (short segment \u0026le;2.5 cm vs. long segment \u0026gt;2.5 cm) shows no significant impact on success (p=0.763). The surgical approach, whether BMG or EPA, does not significantly influence success rates (p=0.795). Lastly, the type of catheter used (latex vs. silicone) also shows no significant difference in success rates (p=0.447).\u003c/p\u003e\n\u003cp\u003eThe findings from the multivariable logistic regression analysis of factors influencing the success rate among patients undergoing urethroplasty revealed several significant associations. Younger patients (\u0026lt;60 years) have significantly higher success rates (94.9%) compared to older patients (70.8%), with COR 0.13 and AOR 0.09. Among etiologies, infectious causes have higher odds of success (73.7%) compared to unknown causes, with COR 10.0 and AOR 13.12. Traumatic and iatrogenic causes do not show significant differences. The level and length of the stricture, surgical approach, and catheter type do not significantly impact success rates. Notably, younger age and infectious etiology are associated with better treatment outcomes. See table 4 below.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe American Urological Association released updated guidelines in 2016 for the treatment of urethral stricture disease. These guidelines outline various approaches to managing urethral strictures, such as end-to-end primary anastomosis (EPA) and augmented urethroplasty, typically using buccal mucosa graft (BMG). The selection of the appropriate technique depends on factors such as the specific location within the urethra affected by the stricture and the length of the stricture itself\u0026nbsp;[7]. The current study investigated the factors influencing the treatment outcomes in patients undergoing urethroplasty for urethral stricture at MNH. The findings of this study are discussed in this chapter.\u003c/p\u003e\n\u003ch2\u003ePatients Characteristics\u003c/h2\u003e\n\u003cp\u003eUntil now, the majority of urethroplasty studies have been characterized by relatively small sample sizes and considerable diversity in patient populations, which has restricted the possibility of conducting subgroup analyses based on particular demographic and clinical features\u0026nbsp;[13,14]. However, the present study faced challenges in achieving a large sample size.\u003c/p\u003e\n\u003cp\u003eUrethral stricture can occur across a wide age range, but there is a notable difference in prevalence between younger and older individuals. This study demonstrated this finding and is in line with studies conducted by Levy et al in Italy, Tinaut-Ranera in Spain and Ofoha et al in Nigeria\u0026nbsp;[13,14,34]. In younger patients, trauma tends to be a more common aetiology, possibly due to activities associated with higher risk, such as sports or motor traffic crash. The findings of this study indicate that trauma is the predominant cause of urethral stricture in younger individuals, accounting for 73.2% of cases. On the other hand, older patients may develop urethral stricture due to a range of factors, including age-related alterations in tissue elasticity, urinary tract infections, or complications arising from medical procedures. Notably, iatrogenic causes were responsible for 70.0% of strictures in older patients in our study. This observation suggested that urinary problems and hospitalizations requiring urethral catheterization and instrumentation may contribute significantly to the development of urethral stricture in this age group. These findings are consistent with those reported in studies by Kimu et al., Musau et al., and El et al\u0026nbsp;[9,11,33].\u003c/p\u003e\n\u003ch2\u003eOutcomes of BMG and EPA urethroplasty\u003c/h2\u003e\n\u003cp\u003eConventionally, the primary approach for treating urethral stricture involves urethral dilatation and/or direct vision internal urethrotomy (DIVU) or Sachse procedures. These methods are preferred due to their simplicity and minimal morbidity. However, despite initial symptom improvement, urethral dilatation or urethrotomy often results in a high rate of recurrence, with endoscopic procedures frequently demonstrating low efficacy. Falavolti et al. highlighted this issue\u0026nbsp;[25]. The current section discusses the findings of various urethroplasty techniques and their respective outcomes.\u003c/p\u003e\n\u003cp\u003eAnastomotic urethroplasty and graft urethroplasty are the prevailing techniques, and exhibit comparable long-term success rates\u0026nbsp;[5,12,13,34]. Despite the increased incidence of urethral strictures with advancing age, there remains a dearth of literature on urethroplasties in elderly patients. In this study, a majority of urethroplasties were performed in younger patients (61.9%) compared to elderly patients (38.9%), a trend consistent with findings from studies by Erickson et al\u0026nbsp;[35]. and Falavolti et al\u0026nbsp;[25]. The contemporary definition of success encompasses both anatomical (where a flexible cystoscope can traverse the reconstructed urethra without difficulty) and functional (with patient-reported amelioration of voiding symptoms and urinary quality of life) criteria\u0026nbsp;[35]. The success rate of urethroplasty in this study was 85.7%. Corresponding studies have reported success rates ranging from approximately 90%, as delineated by Falavolti et al\u0026nbsp;[25]. and Wong et al\u0026nbsp;[36]., with simpler procedures demonstrating higher success rates than complex repairs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBuccal mucosa grafts are favoured due to their ease of procurement, greater availability, resistance to infection, and favourable tissue characteristics\u0026nbsp;[37]. Numerous studies have indicated superior success rates with buccal mucosa grafts compared to end-to-end urethroplasty, even in managing short bulbar strictures\u0026nbsp;[25]. Interestingly, the present study revealed a slightly greater success rate in EPA than in BMG urethroplasty, consistent with the findings from Levy et al\u0026nbsp;[13]., who reported that EPA was superior to BMG for achieving 3-month anatomic success after adjusting for other factors. The outcome of this study could be explained by the preference of surgeons preferring EPA over BMG in MNH. Overall, 15.9% of patients in this study experienced complications, some of whom experienced early complications, some late complications and some experienced both.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFindings from this study were slightly lower compared than those of Al-Qudah et al, who reported complication rates of 21% for anterior anastomotic urethroplasty and 40% for fasciocutaneous onlay urethroplasty\u0026nbsp;[12,36]. Similarly, Andrich et al\u0026nbsp;[38]. Reported a significantly greater complication rate after fasciocutaneous urethroplasty (33%) than after anastomotic urethroplasty (7%). Surgical site infection has emerged as the most prevalent early complication, a topic that has been underexplored in recent literature. The recurrence of stricture manifested as LUTS in patients undergoing both EPA and BMG procedures, albeit more pronounced in BMG patients. Furthermore, erectile dysfunction was reported in 2 patients who underwent EPA, consistent with findings from Al-Qudah et al\u0026nbsp;[12].\u003c/p\u003e\n\u003ch2\u003eFactors influencing urethroplasty outcomes\u003c/h2\u003e\n\u003cp\u003eWhile previous studies have explored factors predicting postoperative outcomes of urethroplasty, such as success, complications, and recurrence in patients with urethral strictures, these studies frequently have limited scope, focusing solely on specific stricture locations (e.g., bulbar strictures) or individual urethroplasty techniques. Given the size and diversity of the patient, this study could incorporate variables such as stricture length and location, among others to study urethroplasty outcomes. To explore potential predictors that may impact the outcomes of urethroplasty, factors including age, aetiology, level and length of stricture, surgical technique, and type of catheter employed were considered.\u003c/p\u003e\n\u003cp\u003eThere is conflicting evidence regarding the successful outcomes of urethroplasty in the elderly population\u0026nbsp;[31,40,41]. This study revealed that younger age was significantly associated with successful urethroplasty, while older age was associated with lower odds of success. This finding aligns with findings from previous studies investigating age in relation to urethroplasty. For instance, Schwentner et al\u0026nbsp;[40]. observed a greater urethroplasty failure rate in older patients, although the study did not account for variations in comorbidities between groups. Conversely, in a series of 604 urethroplasties conducted in a tertiary referral center, factors such as stricture length, lichen sclerosus, iatrogenic and infectious aetiology, rather than age over 50 years, were independently linked to stricture recurrence\u0026nbsp;[31]. Similarly, Santucci et al\u0026nbsp;[39]\u0026nbsp;demonstrated in a multicentric series involving different urethroplasty techniques that there was a comparable incidence of postoperative complications and treatment failure in patients older than 65 years compared to their younger counterparts (\u0026lt;65 years old).\u003c/p\u003e\n\u003cp\u003eAge had a notable impact on outcomes, particularly concerning success rates and complications. Interestingly, despite the older group exhibiting significantly greater rates of comorbidities, the outcomes remained statistically similar. Specifically, hypertension was notably more prevalent among older men; however, it did not emerge as a significant predictor of either success or complication rates. Although many 60-year-old men may exhibit functional and biological characteristics that suggest that they are younger than their chronological age, it is a well-established epidemiological fact that the prevalence of comorbidities tends to increase with advancing age. In terms of surgical approach, EPA initially appeared to outperform BMG, but it did not emerge as a statistically significant predictor for success when other factors were controlled (p=0.656). However, it is important to note that this comparison was not the primary focus of the study but rather a factor that was controlled for as a confounder.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNotably, stricture length did not emerge as a predictor of functional success, potentially due to the relatively small sample size.\u003c/p\u003e"},{"header":"LIMITATIONS, CONCLUSION AND RECOMMENDATIONS","content":"\u003ch2\u003eLimitations\u003c/h2\u003e\n\u003cp\u003eThe limitations of this study stem from its single-center design and retrospective nature,\u0026nbsp;lack of objective assessment tool like uroflowmetry to determine the success or failure. Although efforts were made to collect comprehensive data from patient files, some information were missing or incomplete.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConclusion\u003c/h2\u003e\n\u003cp\u003eThis study evaluated 126 patients who underwent urethroplasty, revealed diverse demographics affected by urethral stricture, with trauma being the leading cause. The bulbar urethra was the most commonly affected site, and comorbidities such as diabetes and hypertension were observed. A preference for EPA over BMG procedures was noted, potentially influenced by patient age and aetiology, particularly trauma at the bulbar urethra level. The complication rates were notable, emphasizing the importance of thorough postoperative care. Additionally, younger age and infectious aetiology were associated with higher success rates of urethroplasty, while iatrogenic aetiology was correlated with lower success rates. Overall, these findings emphasize the need for personalized management approaches in urethroplasty patients, considering individual factors such as age and aetiology to optimize outcomes and minimize complications.\u003c/p\u003e\n\u003ch2\u003eRecommendations\u003c/h2\u003e\n\u003cp\u003eBased on the findings of this research, it is recommended that urethroplasty be considered as a viable option for treating urethral strictures, even in older patients. Further studies should aim to investigate the impact of specific comorbidities, such as hypertension, on the outcomes of urethroplasty in older patients. Additionally, longitudinal studies with larger sample sizes are needed to validate the findings of this research and explore the long-term success rates and complications associated with different urethroplasty techniques. Furthermore, research focusing on the optimal management strategies for urethral strictures in elderly populations, considering factors such as age-related changes in tissue elasticity and vascular supply, would be beneficial for informing clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI Body Mass Index\u003c/p\u003e\n\u003cp\u003eBMG Buccal Mucosa Grafting\u003c/p\u003e\n\u003cp\u003eDVIU Direct Vision Internal Urethrotomy\u003c/p\u003e\n\u003cp\u003eEPA Excision and Primary Anastomosis\u003c/p\u003e\n\u003cp\u003eGU Genitourinary\u003c/p\u003e\n\u003cp\u003eLUTS Lower Urinary Tract Symptoms\u003c/p\u003e\n\u003cp\u003eMCS Microscopic Culture and Sensitivity\u003c/p\u003e\n\u003cp\u003eMNH Muhimbili National Hospital\u003c/p\u003e\n\u003cp\u003eMUHAS Muhimbili University of Health and Allied Science\u003c/p\u003e\n\u003cp\u003eMUS Male urethral stricture\u003c/p\u003e\n\u003cp\u003eNLR Neutrophil to Lymphocyte Ratio\u003c/p\u003e\n\u003cp\u003eTUR Transurethral resection\u003c/p\u003e\n\u003cp\u003eUTI Urinary Tract Infection\u003c/p\u003e\n\u003cp\u003eUSD Urethral stricture disease\u003c/p\u003e\n\u003cp\u003eSPSS Statistical Package for the Social Sciences\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board and was granted ethical approval (Ref. No. DA.282/298/01.C/1964). A waiver for consent was issued by MUHAS since the principal investigator was solely working on medical records. This research adheres to the ethical guidelines and complies with all applicable local and international regulations.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003ePermission for publication was obtained from the institutions involved in this study. The confidentiality and privacy of individuals involved in this research have been rigorously maintained, and no details that could disclose patient\u0026rsquo;s identity are presented in the manuscript.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe research conducted herein was not funded by any external grants or financial support. All work presented in this study was carried out independently, and the authors did not receive any financial assistance from individuals, organizations, or institutions.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eN.H.M-conception and design of the study, data acquisition and analysis, interpretation of results, drafting and revising the manuscript.G.F.M-conceptualization and design of the study, overseeing data collection, performing statistical analysis, interpreting results, and contributing significantly to manuscript writing and revision as a co-supervisor.A.M-overall study design, supervised data collection and analysis, interpreted results, and made substantial contributions to the drafting and critical revision of the manuscript as the supervisor.A.M.A \u0026amp; J.K.M-participated in analysis, and interpretation. Additionally, they contributed to drafting and critically reviewing the manuscript for intellectual content.A.H.M,O.V.N \u0026amp; C.A.M-contributed to the study design, data acquisition and interpretation, and provided valuable insights during manuscript drafting and revision. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study is available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSmith AL, Ferlise VJ, Rovner ES. Female urethral strictures: Successful management with long-term clean intermittent catheterization after urethral dilatation. BJU Int. 2006;98(1):96\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKay HE, Srikanth P, Srivastava A V., Tijerina AN, Patel VR, Hauser N, et al. Preoperative and intraoperative factors predictive of complications and stricture recurrence following multiple urethroplasty techniques. BJUI Compass. 2021;2(4):286\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eNyongole O, Akoko L, Mwanga A, Mkony C. ISSN 2073-9990 East Cent. Afr. J. surg. (Online). Urethral Strict as seen Dar es Salaam, Tanzania [Internet]. 2013;18(April):84\u0026ndash;9. Available from: https://www.ajol.info/index.php/ecajs/article/view/89929\u003c/li\u003e\n\u003cli\u003ePodesta M, Podesta MJ. Traumatic Posterior Urethral Strictures in Children and Adolescents. Front Pediatr. 2019;7:24. \u003c/li\u003e\n\u003cli\u003eEshiobo I, Ernest U. A Review of the epidemiology and management of urethral stricture disease in Sub-Saharan Africa. Curr Med Issues. 2019;17(4):118. \u003c/li\u003e\n\u003cli\u003eRourke K, Hickle J. The clinical spectrum of the presenting signs and symptoms of anterior urethral stricture: Detailed analysis of a single institutional cohort. Urology [Internet]. 2012;79(5):1163\u0026ndash;7. Available from: http://dx.doi.org/10.1016/j.urology.2012.01.044\u003c/li\u003e\n\u003cli\u003eSmith TG 3rd. Current management of urethral stricture disease. Indian J Urol. 2016;32(1):27\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eMundy AR, Andrich DE. Urethral strictures. BJU Int. 2011 Jan;107(1):6\u0026ndash;26. \u003c/li\u003e\n\u003cli\u003eEl M, Mmed M, Asea U, So B, Mmed M, Uct U, et al. Aaetiology of Urethral Strictures at Moi Teaching and Refferal Hospital. Ann African Surg. 2013;10(1):11\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eIgenge J, Musau P, Mteta AK. Early outcome of the types of urethroplasty in a tertiary centre in Northern Tanzania. Ann African Surg [Internet]. 2013;10(1):32\u0026ndash;5. Available from: https://www.embase.com/search/results?subaction=viewrecord\u0026amp;id=L612650281\u0026amp;from=export\u003c/li\u003e\n\u003cli\u003eMusau P, Mteta AK. Urethral strictures in a tertiary care hospital in Tanzania. East Afr Med J. 2009 Jan;86(1):3\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eAl-Qudah HS, Santucci RA. Extended complications of urethroplasty. Int Braz J Urol. 2005;31(4):315\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eLevy M, Gor RA, Vanni AJ, Stensland K, Erickson BA, Myers JB, et al. The Impact of Age on Urethroplasty Success. Urology [Internet]. 2017;107:232\u0026ndash;8. Available from: https://doi.org/10.1016/j.urology.2017.03.066\u003c/li\u003e\n\u003cli\u003eOfoha CG, Ramyil VM, Dakum NK, Shu\u0026rsquo;aibu SI, Akpayak IC, Magnus FE, et al. Predictors of urethral stricture recurrence following urethroplasty: a retrospective review at the Jos University Teaching Hospital, Nigeria. Pan Afr Med J. 2019;32:190. \u003c/li\u003e\n\u003cli\u003eFu Q, Zhang Y meng, Barbagli G, Zhang J, Xie H, Sa Y long, et al. Factors that influence the outcome of open urethroplasty for pelvis fracture urethral defect (PFUD): an observational study from a single high-volume tertiary care center. World J Urol [Internet]. 2015;33(12):2169\u0026ndash;75. Available from: http://dx.doi.org/10.1007/s00345-015-1533-4\u003c/li\u003e\n\u003cli\u003eLazzeri M, Sansalone S, Guazzoni G, Barbagli G. Incidence, Causes, and Complications of Urethral Stricture Disease. Eur Urol Suppl. 2016;15(1):2\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eAlwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014 Jun;3(2):209\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eChapman D, Kinnaird A, Rourke K. Independent Predictors of Stricture Recurrence Following Urethroplasty for Isolated Bulbar Urethral Strictures. J Urol [Internet]. 2017;198(5):1107\u0026ndash;12. Available from: http://dx.doi.org/10.1016/j.juro.2017.05.006\u003c/li\u003e\n\u003cli\u003eMeeks JJ, Erickson BA, Granieri MA, Gonzalez CM. Stricture Recurrence After Urethroplasty: A Systematic Review. J Urol [Internet]. 2009;182(4 SUPPL.):1266\u0026ndash;70. Available from: http://dx.doi.org/10.1016/j.juro.2009.06.027\u003c/li\u003e\n\u003cli\u003eCheng X, Ding M, Peng M, Zhou L, Li Y, Peng S, et al. The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China. Front Public Heal. 2021;9(December):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003ePierpont YN, Dinh TP, Salas RE, Johnson EL, Wright TG, Robson MC, et al. Obesity and surgical wound healing: a current review. ISRN Obes. 2014;2014:638936. \u003c/li\u003e\n\u003cli\u003eChapman D, Kinnaird A, Rourke A. Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures. J Urol. 2017;179:1107\u0026ndash; 12. \u003c/li\u003e\n\u003cli\u003eBreyer B, Mc Aninch J, Whitson J. Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol. 2010;183(2):613617. \u003c/li\u003e\n\u003cli\u003eAlma A, Marconi GD, Rossi E, Magnoni C, Paganelli A. Obesity and Wound Healing: Focus on Mesenchymal Stem Cells. Life [Internet]. 2023;13(3). Available from: https://www.mdpi.com/2075-1729/13/3/717\u003c/li\u003e\n\u003cli\u003eFalavolti C. Urethral Structure Length \u0026ge; 2 cm is Significantly Associated with Lower Urethroplasty Success Rate, Results of our Large Case Series. Biomed J Sci Tech Res. 2018;9(5):7371\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eBullock TL BS. Adult anterior urtethral stricture: a national practice patterns surveys of board certified urologists in the united states. J Urol. 2007;177(2):685-690. \u003c/li\u003e\n\u003cli\u003eG\u0026uuml;r A, S\u0026ouml;nmez G, Demirtaş T, Tombul ŞT, Halitgil K, Demirtaş A. Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience. Cureus. 2021 Nov;13(11):e19663. \u003c/li\u003e\n\u003cli\u003eYildiz I, Gokalp F, Burak C, Karazindiyanoglu S, Yildiz PO, Rencuzogullari I, et al. Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome. J Tehran Heart Cent. 2020 Jul;15(3):113\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAydemir H, Sağlam HS, K\u0026ouml;se O, Erdik A, Halis F, G\u0026ouml;k\u0026ccedil;e A. The effect of recurrent direct vision internal urethrotomy for short anterior urethral strictures on the disease course and the predictors of treatment failure. Can Urol Assoc J. 2019;13(11). \u003c/li\u003e\n\u003cli\u003eRoehrborn CG, McConnell JD. Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol. 1994;151(4):869\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eKinnaird A, Levine M, Ambati D, Zorn J, Rourke K. Stricture length and aetiology as preoperative independent predictors of recurrence after urethroplasty: a multivariate analysis of 604 urethroplasties. Can Urol Assoc J. 2014;8:E296. \u003c/li\u003e\n\u003cli\u003eBello JO. Impact of Preoperative Patient Characteristics on Posturethroplasty Recurrence: The Significance of Stricture Length and Prior Treatments. Niger J Surg Off Publ Niger Surg Res Soc. 2016;22(2):86\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eKimu N, Nyongole OV, Frank B, Mbwambo J. Late Outcome of Direct Vision Urethrotomy in Patients with Urethral Stricture at Kilimanjaro Christian Medical Center (KCMC), Moshi- Tanzania. 2015;15(4). \u003c/li\u003e\n\u003cli\u003eTinaut-Ranera J, Arrabal-Polo M\u0026Aacute;, Merino-Salas S, Nogueras-Oca\u0026ntilde;a M, L\u0026oacute;pez-Le\u0026oacute;n VM, Palao-Yago F, et al. Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty. J Can Urol Assoc. 2014;8(1\u0026ndash;2):1\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eErickson BA, Ghareeb GM. Definition of Successful Treatment and Optimal Follow-up after Urethral Reconstruction for Urethral Stricture Disease. Urol Clin North Am. 2017 Feb;44(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eWong SSW, Aboumarzouk OM, Narahari R, O\u0026rsquo;Riordan A, Pickard R. Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men. Cochrane database Syst Rev. 2012 Dec;12:CD006934. \u003c/li\u003e\n\u003cli\u003eBullock TL, Brandes SB. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol. 2007 Feb;177(2):685\u0026ndash;90. \u003c/li\u003e\n\u003cli\u003eAndrich DE, Leach CJ, Mundy AR. The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int. 2001 Sep;88(4):385\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eGallegos MA, Santucci RA. Advances in urethral stricture management. F1000Research. 2016;5:2913. \u003c/li\u003e\n\u003cli\u003eSchwentner C, Seibold J, Colleselli D, Alloussi SH, Schilling D, Sievert KD, et al. Dorsal onlay skin graft urethroplasty in patients older than 65 years. Urology. 2010 Aug;76(2):465\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eHeyns CF, van der Merwe J, Basson J, van der Merwe A. Treatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty. S Afr J Surg. 2012 Jul;50(3):82\u0026ndash;7. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Characteristics of patients undergoing urethroplasty, N=126\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"582\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eAge in years (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e51 \u0026plusmn; 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eLength of stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eLong segment (\u0026gt;2.5 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eShort segment (\u0026le;2.5 cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eStricture level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003ePenile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003ePeno-bulbar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e31.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eBulbar-urethra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e54.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eBulbo-membranous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eAetiology of stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eTraumatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eIatrogenic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eInfectious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eNon-urological malignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eSurgery type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eBMG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e39.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eEPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46.3918%;\"\u003e\n \u003cp\u003eUrethral catheter type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eLatex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.95189%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42.4399%;\"\u003e\n \u003cp\u003eSilicone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.8041%;\"\u003e\n \u003cp\u003e58.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2: Outcome of urethroplasty among patients undergoing BMG and EPA\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 47.5548%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 47.5548%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eFail/recurred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 47.5548%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e84.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 47.5548%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eSSI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003ePainful scrotum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eWound dehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 47.5548%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eIrritative \u0026plusmn; Obstructive LUTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eStress incontinence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 3.03541%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44.5194%;\"\u003e\n \u003cp\u003eErectile dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.3187%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.1265%;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eLUTS; Lower urinary tract symptoms\u003c/p\u003e\n\u003cp\u003eSSI; Surgical site infection\u003c/p\u003e\n\u003cp\u003eTable 3: Chi-square test for factors associated with success of urethroplasty\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuccess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eAge during treatment (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eYoung (\u0026lt;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e74 (94.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eOld (\u0026ge; 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e34 (70.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e14 (29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eEtiologies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eTraumatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e47 (83.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e9 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eIatrogenic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e19 (86.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3 (13.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eInfectious\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e14 (73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e28 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eLevel of stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003ePenile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003ePeno-bulbar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e35 (89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eBulbar-urethra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e58 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e10 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eBulbo-membranous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eLength of stricture (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.763\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eShort segment \u0026le;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e82 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e15 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eLong segment \u0026gt;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e26 (89.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eSurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eBMG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e42 (84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e8 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eEPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e66 (86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e10 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eCatheter type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eLatex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e43 (82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 216px;\"\u003e\n \u003cp\u003eSilicone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e65 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e9 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;4: Multivariable logistic regression of factors affecting urethroplasty success rate\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95%Cl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95%Cl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 348px;\"\u003e\n \u003cp\u003eAge during treatment (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eYoung (\u0026lt;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.13 (0.04 \u0026ndash; 0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.09 (0.03 \u0026ndash; 0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eOld (\u0026ge; 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eEtiologies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eTraumatic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e5.3 (0.65 \u0026ndash; 44.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8.14 (0.89 \u0026ndash; 73.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eIatrogenic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e4.42 (0.43 \u0026ndash; 45.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2.38 (0.22 \u0026ndash; 26.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eInfectious\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e10.0 (1.06 \u0026ndash; 94.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e13.12 (1.23 \u0026ndash; 139.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLevel of stricture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003ePenile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.09 (0.08 \u0026ndash; 13.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003ePeno-bulbar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.46 (0.04 \u0026ndash; 5.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eBulbar-urethra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e0.70 (0.07 \u0026ndash; 6.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eBulbo-membranous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eLength of stricture (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eShort segment \u0026le;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.5 (0.43 \u0026ndash; 5.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eLong segment \u0026gt;2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eSurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eBMG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.26 (0.46 \u0026ndash; 3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eEPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eCatheter type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eLatex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e1.51 (0.55 \u0026ndash; 4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003eSilicone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 642px;\"\u003e\n \u003cp\u003e1. AOR: Adjusted Odds Ratio\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2. COR: Crude Odds Ratio\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3. Cl: Confidence limit\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4. Bold p-value means significant at p \u0026lt; 0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Influencing factors, treatment outcomes, urethroplasty","lastPublishedDoi":"10.21203/rs.3.rs-5347572/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5347572/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Urethral stricture disease poses a substantial challenge in Sub-Saharan Africa, where the prevalence is notably high. This condition predominantly impacts men, and the underlying causes in the region are diverse and varied. There is a significant research gap in understanding the patient-related factors that contribute to the outcomes of urethroplasty for urethral strictures at Muhimbili National Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives:\u003c/strong\u003e To determine the factors influencing treatment outcomes among patients undergoing urethroplasty for urethral stricture at Muhimbili National Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e This cross-sectional analytical study was carried out at Muhimbili National Hospital. Through convenient sampling, data from the hospital’s patient database, specifically from patients aged 10 years and above, were extracted using a structured abstraction form. Patient information, clinical findings, treatment offered and treatment outcomes were collected. The collected data were analyzed using SPSS 23.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study examined 126 patients with urethral stricture who underwent urethroplasty at MNH between January 2020 and December 2022. The mean age was 51 years, with the bulbar urethra being the most common stricture site (54%) and trauma the leading cause (44.4%). The success rate of urethroplasty was 85.7%, with a 15.9% complication rate. Early complications included surgical site infections (54.5%), painful scrotum (36.4%), and wound dehiscence (9.1%). Late complications predominantly consisted of irritative lower urinary tract symptoms (83.3%), stress incontinence (5.6%), and erectile dysfunction (11.1%). Younger patients (\u0026lt;60 years) and those with infectious etiologies had significantly higher success rates. The type of stricture, length of stricture, surgical approach, and catheter type did not significantly impact outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Urethroplasty had a high success rate of 85.7%, particularly in younger patients and those with infectious etiologies. Trauma was identified as the most common cause of urethral strictures, primarily affecting the bulbar urethra. Postoperative complications, both early and late, were observed, indicating the need for careful postoperative monitoring. Factors such as stricture level, length, surgical approach, and catheter type did not significantly impact the success of urethroplasty.\u003c/p\u003e","manuscriptTitle":"Factors Influencing the Treatment Outcomes of Patients Undergoing Urethroplasty for Urethral Stricture at Muhimbili National Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-02 23:08:30","doi":"10.21203/rs.3.rs-5347572/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a783823c-d608-49fa-a0ee-d24b0fa310f2","owner":[],"postedDate":"December 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-11T14:08:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-02 23:08:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5347572","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5347572","identity":"rs-5347572","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}