Histopathology of Anterior Urethral Strictures: Toward a Better Understanding of Stricture Pathophysiology

Matthew D Grimes; Brennan A Tesdahl; Morgan Schubbe; Lalia Dahmoush; Amy M Pearlman; Karl J Kreder; Bradley A Erickson

doi:10.1097/JU.0000000000000340

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Histopathology of Anterior Urethral Strictures: Toward a Better Understanding of Stricture Pathophysiology

Journal article

Open access

Peer reviewed

Histopathology of Anterior Urethral Strictures: Toward a Better Understanding of Stricture Pathophysiology

Matthew D Grimes, Brennan A Tesdahl, Morgan Schubbe, Lalia Dahmoush, Amy M Pearlman, Karl J Kreder and Bradley A Erickson

The Journal of urology, Vol.202(4), pp.748-755

10/2019

DOI: 10.1097/JU.0000000000000340

PMCID: PMC6856362

PMID: 31091176

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Abstract

Histopathology can provide insights into disease mechanisms but to date it has been poorly described for urethral stricture. The purpose of this study was to comprehensively describe histopathological findings of stricture specimens obtained at the time of anterior urethroplasty. All pathological specimens of men who underwent anterior urethroplasty of urethral stricture disease from 2010 to 2017 at a single institution were rereviewed by a single blinded pathologist directed to rule out lichen sclerosus and then describe inflammatory cell type and severity when present. Cohorts comprising strictures with no inflammation, minimal to mild inflammation or moderate to severe inflammation were developed and stricture, patient and surgical outcome characteristics were compared. Histopathology slides from 100 anterior urethroplasty cases were reviewed. Two or more lichen sclerosus characteristics were present in 21% of specimens and 44% of specimens showed chronic inflammation, which was minimal in 20%, mild in 39%, moderate in 39% and severe in 2%. Lymphocytes in 86% of specimens and plasma cells in 12% were the predominant cell types. Patients with inflammatory stricture reported worse overall health. Inflammation was largely absent from isolated bulbomembranous strictures (9%) and more common in lichen sclerosus strictures (100%). The 11% overall failure rate was not affected by the presence (7%) or absence (14%) of inflammation. Chronic inflammation is prevalent in a significant percent of urethral stricture disease specimens. Associations with worse overall health suggest systemic mediators. Absent inflammation in bulbomembranous strictures suggests a unique pathophysiology in this region. The presence of inflammation did not affect surgical outcomes at mid-term followup.

Urethra - surgery

Lichen Sclerosus et Atrophicus - pathology

Prevalence

Follow-Up Studies

Humans

Middle Aged

Urethral Stricture - etiology

Male

Treatment Outcome

Urethritis - complications

Lichen Sclerosus et Atrophicus - complications

Urethra - pathology

Urethral Stricture - pathology

Urethral Stricture - surgery

Urologic Surgical Procedures, Male

Urethritis - pathology

Lichen Sclerosus et Atrophicus - epidemiology

Adult

Retrospective Studies

Urethritis - epidemiology

Reconstructive Surgical Procedures

Details

Title: Subtitle: Histopathology of Anterior Urethral Strictures: Toward a Better Understanding of Stricture Pathophysiology
Creators: Matthew D Grimes - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Brennan A Tesdahl - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Morgan Schubbe - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Lalia Dahmoush - Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Amy M Pearlman - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Karl J Kreder - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Bradley A Erickson - Department of Urology, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The Journal of urology, Vol.202(4), pp.748-755
DOI: 10.1097/JU.0000000000000340
PMID: 31091176
PMCID: PMC6856362
NLM abbreviation: J Urol
ISSN: 0022-5347
eISSN: 1527-3792
Publisher: United States
Grant note: R21 DK115945 / NIDDK NIH HHS
Language: English
Date published: 10/2019
Academic Unit: Pathology; Obstetrics and Gynecology; Urology
Record Identifier: 9984051588102771

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