The Impact of Social Deprivation on Anterior Urethral Stricture Recurrence After Urethroplasty – A Trauma and Urologic Reconstructive Network of Surgeons (TURNS) Analysis

No AccessJournal of UrologyOriginal Clinical Article1 Aug 2024The Impact of Social Deprivation on Anterior Urethral Stricture Recurrence After Urethroplasty – A Trauma and Urologic Reconstructive Network of Surgeons (TURNS) Analysis Hiren V. Patel, Kevin D. Li, Keith Rourke, Thomas G. Smith, Bryan B. Voelzke, Jeremy B. Myers, Joshua A. Broghammer, Nejd F. Alsikafi, Jill C. Buckley, Lee C. Zhao, Sean P. Elliott, Alex J. Vanni, Andrew C. Peterson, Bradley A. Erickson, and Benjamin N. Breyer Hiren V. PatelHiren V. Patel https://orcid.org/0000-0002-6475-670X Department of Urology, University of California San Francisco, San Francisco, California , Kevin D. LiKevin D. Li Department of Urology, University of California San Francisco, San Francisco, California , Keith RourkeKeith Rourke https://orcid.org/0000-0003-4971-8657 Division of Urology, University of Alberta, Edmonton, Alberta , Thomas G. SmithThomas G. Smith Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas , Bryan B. VoelzkeBryan B. Voelzke https://orcid.org/0000-0002-0887-9887 Spokane Urology, Spokane, Washington , Jeremy B. MyersJeremy B. Myers https://orcid.org/0000-0002-5786-1552 Division of Urology, University of Utah, Salt Lake City, Utah , Joshua A. BroghammerJoshua A. Broghammer https://orcid.org/0000-0003-2691-5076 Department of Urology, University of Kansas, Kansas City, Kansas , Nejd F. AlsikafiNejd F. Alsikafi https://orcid.org/0000-0001-7031-8346 Uropartners, Gurnee, Illinois , Jill C. BuckleyJill C. Buckley https://orcid.org/0000-0002-9766-2750 Department of Urology, University of San Diego Health System, San Diego, California , Lee C. ZhaoLee C. Zhao https://orcid.org/0000-0002-4029-0669 Department of Urology, New York University Langone Medical Center, New York City, New York , Sean P. ElliottSean P. Elliott https://orcid.org/0000-0002-5280-2449 Department of Urology, University of Minnesota, Minneapolis, Minnesota , Alex J. VanniAlex J. Vanni https://orcid.org/0000-0002-0755-0094 Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts , Andrew C. PetersonAndrew C. Peterson Department of Urology, Duke University Medical Center, Durham, North Carolina , Bradley A. EricksonBradley A. Erickson https://orcid.org/0000-0001-5237-3464 Department of Urology, University of Iowa, Iowa City, Iowa , and Benjamin N. BreyerBenjamin N. Breyer Corresponding Author: Benjamin N. Breyer, MD, MAS, FACS, Department of Urology, University of California Francisco, Box 0738, 400 Parnassus Ave, A632, San Francisco, CA 94143 ( (email protected) ). https://orcid.org/0000-0002-0532-048X View All Author Informationhttps://doi.org/10.1097/JU.0000000000004188AboutPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Introduction and Objectives: Several factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is poorly understood. This study aims to assess the impact that social deprivation, an area-level measure of disadvantage, has on urethral stricture recurrence after urethroplasty. Methods: We performed a retrospective review of patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Home zip code was used to calculate Social Deprivation Indices (SDI; 0-100), which quantifies the level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code data were excluded from the analysis. The Cox Proportional Hazards model was used to study the association between SDI and the hazard of functional recurrence, adjusting for stricture characteristics as well as age and body mass index. Results: Median age was 46.0 years with a median follow up of 367 days for the 1452 men included in the study. Patients in the fourth SDI quartile (worst social deprivation) were more likely to be active smokers with traumatic and infectious strictures compared to the first SDI quartile. Patients in the fourth SDI quartile had 1.64 times the unadjusted hazard of functional stricture recurrence vs patients in the first SDI quartile (95% CI 1.04-2.59). Compared to anastomotic ± excision, substitution only repair had 1.90 times the unadjusted hazard of recurrence. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95% CI 1.01-1.15, P = .027). Conclusions: Patient social deprivation identifies those at higher risk for functional recurrence after anterior urethral stricture repair, offering an opportunity for preoperative counseling and postoperative surveillance. Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Supplementary Materials Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordssocial determinants of healthneighborhood disadvantageurethral stricturerecurrenceurethroplastyMetrics Author Information Hiren V. Patel Department of Urology, University of California San Francisco, San Francisco, California Co-first authors. More articles by this author Kevin D. Li Department of Urology, University of California San Francisco, San Francisco, California Co-first authors. More articles by this author Keith Rourke Division of Urology, University of Alberta, Edmonton, Alberta More articles by this author Thomas G. Smith Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas More articles by this author Bryan B. Voelzke Spokane Urology, Spokane, Washington More articles by this author Jeremy B. Myers Division of Urology, University of Utah, Salt Lake City, Utah More articles by this author Joshua A. Broghammer Department of Urology, University of Kansas, Kansas City, Kansas More articles by this author Nejd F. Alsikafi Uropartners, Gurnee, Illinois More articles by this author Jill C. Buckley Department of Urology, University of San Diego Health System, San Diego, California More articles by this author Lee C. Zhao Department of Urology, New York University Langone Medical Center, New York City, New York More articles by this author Sean P. Elliott Department of Urology, University of Minnesota, Minneapolis, Minnesota More articles by this author Alex J. Vanni Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts More articles by this author Andrew C. Peterson Department of Urology, Duke University Medical Center, Durham, North Carolina More articles by this author Bradley A. Erickson Department of Urology, University of Iowa, Iowa City, Iowa More articles by this author Benjamin N. Breyer Corresponding Author: Benjamin N. Breyer, MD, MAS, FACS, Department of Urology, University of California Francisco, Box 0738, 400 Parnassus Ave, A632, San Francisco, CA 94143 ( (email protected) ). More articles by this author Expand All Advertisement PDF downloadLoading ...