Abstract
MP06-14 MULTIVARIABLE OUTCOMES MODEL FOR BULBAR URETHROPLASTY SHOWS ACTIVE SMOKING IS PROTECTIVE AGAINST FUNCTIONAL SURGICAL FAILURE
The Journal of urology, Vol.211(5S)
05/2024
DOI: 10.1097/01.JU.0001009452.79331.fd.14
Abstract
INTRODUCTION AND OBJECTIVE:
Smoking cessation prior to surgery is encouraged to minimize cardiac and pulmonary anesthetic risk, but also to improve wound healing, as the nicotine in cigarette smoke decreases microvascular blood supply. Still, many patients will not heed this advice and will smoke up to and throughout surgery. The focus in this study was to determine how active smoking affects urethroplasty outcomes.
METHODS:
A large multi-institutional database was used to identify patients that underwent anterior urethroplasty for bulbar urethral stricture disease (bUSD). Patients with bUSD in prior hypospadias repair sites or from lichen sclerosus were excluded. A generalized linear mixed model was created to predict surgical functional failure (need for secondary procedure for recurrence) after single-stage orthotopic urethroplasty. The following variables were included: bUSD length (cm), location (proximal(S1a)/distal(S1b), etiology, endoscopic dilation/incision counts (n), age (years), and smoking status (never/former and active – with former defined as quit>1 month before surgery). Leak rates and wound complications were also assessed.
RESULTS:
There were 1,464 men that underwent urethroplasty for bUSD, of which 150 (10.2%) were active smokers. The overall failure rate was 8.5%. Factors significantly associated with failure included length (OR 1.3, per cm) and etiology: failed urethroplasty (E3b; OR 2.2), and radiation (E3c; OR 5.3). Active smoking was strongly protective (OR 0.2; overall smoker recurrence rate 3%). The overall leak rate was 2.9% (n=42), which was higher in smokers (6% v. 2.5%; p=0.03). The wound infection rates were similar (2.7% v. 1.3%; p=0.3). Smoking did not affect urethroplasty type when controlling for stricture length (p=0.84).
CONCLUSIONS:
Active smoking significantly increases the odds of functional success (OR 4.2; p=0.006) after bulbar urethroplasty. While this finding appears counterintuitive, a mechanism can be elucidated that has been used to explain similar findings in the plastics literature: nicotine is known to inhibit inflammation and collagen synthesis. This mechanism may simultaneously explain the smoker’s higher urine leak rate and lower failure through a shared anti-fibrotic mechanism. Harnessing the apparent protective effects of nicotine without tobacco will require further study, but these data suggest that urethroplasty success might be augmented by slowing the inflammatory and proliferative phases of wound healing.
Details
- Title: Subtitle
- MP06-14 MULTIVARIABLE OUTCOMES MODEL FOR BULBAR URETHROPLASTY SHOWS ACTIVE SMOKING IS PROTECTIVE AGAINST FUNCTIONAL SURGICAL FAILURE
- Creators
- Mei N.E. TuongCharles SchlaepferAlithea ZornJacob OlesonNejd AlsikafiBenjamin BreyerJoshua BroghammerJill BuckleyEric ChoIsabella DolendoSean ElliottShawn GroveMarcus JamilJane KurtzmanJeremy MyersHiren PatelAndrew PetersonJohn RatanawongKeith RourkeThomas SmithAlex VanniBryan VoelzkeLee ZhaoBradley Erickson
- Resource Type
- Abstract
- Publication Details
- The Journal of urology, Vol.211(5S)
- DOI
- 10.1097/01.JU.0001009452.79331.fd.14
- ISSN
- 0022-5347
- eISSN
- 1527-3792
- Publisher
- American Urological Association
- Language
- English
- Date published
- 05/2024
- Academic Unit
- Epidemiology; Biostatistics; Urology; Otolaryngology
- Record Identifier
- 9984649056002771
Metrics
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