Histopathologic and Clinical Comparison of Recurrent and Non-recurrent Urethral Stricture Disease Treated by Reconstructive Surgery

Overview

Journal Transl Androl Urol

Date 2021 Nov 22

PMID 34804815

Citations 2

Authors

Iryna V Samarska

Hasan Dani

Trinity J Bivalacqua

Arthur L Burnett

Andres Matoso

Affiliations

Soon will be listed here.

Abstract

Background: Urethral stricture is a relatively frequent problem often requiring multiple surgical interventions. The objective of this study was to compare the clinicopathologic features of urethral resections from patients who underwent open end-to-end anastomotic urethroplasty and later recurred compared to those who did not.

Methods: A retrospective review of the pathology files identified 36 consecutive patients who underwent urethroplasty. The histopathological analysis included evaluation of the inflammatory infiltrate based on the predominant (>50%) cell type: lymphocyte-rich, neutrophil-rich, plasma cell-rich, and mixed; length and thickness of the fibrous plaque; and the cellularity of the fibrous plaque: cellular (>40 stroma nuclei/HPF) or paucicellular (<40 stroma nuclei/high power field).

Results: Ten (28%) patients recurred, and 26 (72%) did not. There was no significant difference between recurrent and non-recurrent cases in age, race, comorbidities, location of the stricture, and etiology. All patients with recurrent strictures showed dense paucicellular fibrotic plaques (10/10; 100%), while this was seen in 14/26 (53.8%) non-recurrent cases (P=0.01). Only one patient with cellular fibrosis showed recurrence during follow-up. The log-rank test shows that time to recurrence is significantly shorter in patients with paucicellular fibrosis compared to those with cellular fibrosis (P=0.036). The inflammation consisted of a mixed population of CD3(+) T-lymphocytes, CD20(+) B-lymphocytes, and CD68(+) histiocytes, and there was no difference in the composition of the inflammation between groups. All cases with plasma cell-rich infiltrate showed normal IgG4:IgG.

Conclusions: Our study supports reporting cellularity of the fibrous plaque as a potential predictor of outcome in patients undergoing reconstructive urethroplasty. Patients with paucicellular fibrosis are at increased risk of recurrence.

Citing Articles

UrethroNAV: the aetiology and extent of idiopathic urethral stricture in an Australian population.

Desai D, Harrison W, Raveenthiran S, Samaratunga H, De Win G Transl Androl Urol. 2024; 13(3):423-432.

PMID: 38590965 PMC: 10999018. DOI: 10.21037/tau-23-549.

Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease.

Sterling J, Rahman S, Varghese A, Angulo J, Nikolavsky D J Clin Med. 2023; 12(12).

PMID: 37373644 PMC: 10299043. DOI: 10.3390/jcm12123950.

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