Mp06-14 Multivariable Outcomes Model for Bulbar Urethroplasty Shows Active Smoking Is Protective Against Functional Surgical Failure

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (including stricture) I (MP06)1 May 2024MP06-14 MULTIVARIABLE OUTCOMES MODEL FOR BULBAR URETHROPLASTY SHOWS ACTIVE SMOKING IS PROTECTIVE AGAINST FUNCTIONAL SURGICAL FAILURE Mei N.E. Tuong, Charles Schlaepfer, Alithea Zorn, Jacob Oleson, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Jill Buckley, Eric Cho, Isabella Dolendo, Sean Elliott, Shawn Grove, Marcus Jamil, Jane Kurtzman, Jeremy Myers, Hiren Patel, Andrew Peterson, John Ratanawong, Keith Rourke, Thomas Smith, Alex Vanni, Bryan Voelzke, Lee Zhao, and Bradley Erickson Mei N.E. TuongMei N.E. Tuong , Charles SchlaepferCharles Schlaepfer , Alithea ZornAlithea Zorn , Jacob OlesonJacob Oleson , Nejd AlsikafiNejd Alsikafi , Benjamin BreyerBenjamin Breyer , Joshua BroghammerJoshua Broghammer , Jill BuckleyJill Buckley , Eric ChoEric Cho , Isabella DolendoIsabella Dolendo , Sean ElliottSean Elliott , Shawn GroveShawn Grove , Marcus JamilMarcus Jamil , Jane KurtzmanJane Kurtzman , Jeremy MyersJeremy Myers , Hiren PatelHiren Patel , Andrew PetersonAndrew Peterson , John RatanawongJohn Ratanawong , Keith RourkeKeith Rourke , Thomas SmithThomas Smith , Alex VanniAlex Vanni , Bryan VoelzkeBryan Voelzke , Lee ZhaoLee Zhao , and Bradley EricksonBradley Erickson View All Author Informationhttps://doi.org/10.1097/01.JU.0001009452.79331.fd.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e57 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mei N.E. Tuong More articles by this author Charles Schlaepfer More articles by this author Alithea Zorn More articles by this author Jacob Oleson More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Eric Cho More articles by this author Isabella Dolendo More articles by this author Sean Elliott More articles by this author Shawn Grove More articles by this author Marcus Jamil More articles by this author Jane Kurtzman More articles by this author Jeremy Myers More articles by this author Hiren Patel More articles by this author Andrew Peterson More articles by this author John Ratanawong More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Bryan Voelzke More articles by this author Lee Zhao More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF downloadLoading ...