Prospective assessment of the incidence and associations of postvoid dribbling after urethroplasty Impact of surgical technique

INTRODUCTION: The incidence and associations of postvoid dribbling (PVD) after urethroplasty remains unclear. The purpose of this study was to examine the impact of urethroplasty on PVD and factors associated with de novo PVD. METHODS: From 2011-2018, patients were offered enrollment in a prospective study assessing PVD after urethroplasty. PVD was assessed preoperatively and six months post-surgery with the question, "After urinating, do you have post-urination dribbling or leakage of urine?" Choices included, "Never" (1), "Occasionally" (2), "Sometimes" (3), "Most of the time" (4), or "All of the time" (5). A response of 3-5 was considered clinically significant. Wilcoxon signed-rank test was used to compare pre- and postoperative PVD, while logistic regression was used to determine the association between new-onset PVD and clinical variables. RESULTS: A total of 384 patients completed the study, with 46.9% (180) reporting PVD preoperatively compared to 39.8% (153) postoperatively (p=0.01); 18.0% (67) of patients experienced de novo PVD, 57.0% (219) no change, and 25.0% (96) reported improvement. On multivariable logistic regression, patients undergoing anastomotic urethroplasty were less likely to report de novo PVD (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.13-0.83, p=0.02). No other factor was associated with de novo PVD, including age (p=0.59), stricture length (p=0.71), location (p=0.50), etiology (p=0.59), failed endoscopic treatment (p=0.18), previous urethroplasty (p=0.55), or recurrence (p=0.78). De novo PVD was not associated with patient dissatisfaction (10.1% vs. 7.6%, p=0.49). CONCLUSIONS: PVD is common in patients with urethral stricture. While there is an overall improvement after urethroplasty, 18.0% of patients will experience de novo PVD, with a reduced incidence in those undergoing anastomotic urethroplasty.