Social deprivation up risk of stricture recurrence after urethroplasty

Patients experiencing social deprivation are at greater risk for functional recurrence after anterior urethral stricture repair, suggests a study, noting the importance of preoperative counselling and postoperative surveillance.

A retrospective review was performed on patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Researchers used home zip code to calculate the Social Deprivation Indices (SDIs, 0‒100), which quantify the level of disadvantage across several sociodemographic domains collected in the American Community Survey.

The Cox proportional hazards model was used to explore the relationship between SDI and the hazard of functional recurrence, adjusting for stricture characteristics, age, and BMI.

Overall, 1,452 men (median age 46.0 years) were included in the analysis, with a median follow-up of 367 days. Patients in the fourth SDI quartile (worst social deprivation) tended to be active smokers with traumatic and infectious strictures compared with those in the first SDI quartile.

Men in the fourth SDI quartile also had 1.64-fold (95 percent confidence interval [CI], 1.04‒2.59) higher unadjusted hazard of functional stricture relative to those in the first quartile.

In addition, substitution-only repair resulted in 1.90 times higher unadjusted risk of recurrence than anastomotic ± excision. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95 percent CI, 1.01‒1.15; p=0.027).

“Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery,” the researchers said.