Effectiveness of urethroplasty in strictures and distraction defects of the membranous urethra: a systematic review and meta-analysis

Vorobev V.A., Kogan M.I., Prokopev E.Yu., Pushkarev A.M.

1) Bashkir State Medical University, Ufa, Russia; 2) Irkutsk State Medical University, Irkutsk, Russia; 3) Rostov State Medical University, Rostov-on-Don, Russia; 4) State Budgetary Healthcare Institution «Republican Clinical Hospital» named after G.G. Kuvatov, Ufa, Russia

Objective. To evaluate the outcomes of urethroplasty for strictures and distraction defects of the membranous urethra through a systematic review and meta-analysis, and to supplement these findings with a neural network analysis to identify key predictors of success.
Materials and methods. Ten original studies (totaling 930 patients) meeting criteria were included. The primary outcome was defined as the absence of restenosis, confirmed by urethrography/cystoscopy. Proportions were meta-analyzed using logit transformation and a random-effects model (for I² >50%). Kaplan–Meier survival analysis was performed for overall and subgroup (traumatic vs. radiation-induced strictures) recurrence-free survival. An experimental neural network model (three hidden layers with ReLU activation) was developed using inputs such as stricture length, etiology, and history of prior interventions to predict success probability.
Results. The overall success rate was 88.3% (95% CI 85–91%). Subgroup analysis revealed that traumatic strictures achieved success rates of 90–95%, while radiation-induced strictures had lower rates (70–80%, p=0.03). Kaplan–Meier curves showed 5-year recurrence-free survival of 87% for traumatic and 70% for radiation-induced cases. The neural network confirmed that stricture length and previous interventions are the most critical predictors of failure, with age and comorbidities playing a secondary role.
Conclusions. Anastomotic urethroplasty is a highly effective treatment for membranous urethral strictures, particularly in traumatic cases. In radiation-induced strictures, the risk of restenosis and complications is higher, necessitating specialized management and close follow-up during the first 1–2 years post-surgery. Neural network analysis provides valuable personalized outcome predictions that can help optimize treatment strategies.

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About the Authors

Corresponding author: V.A. Vorobev – Doctor of Medical Sciences, M.D.; Professor of the Department of Faculty Surgery and Urology at the Federal State Budgetary Educational Institution of Higher Education “Irkutsk State Medical University” of the Ministry of Health of the Russian Federation, Irkutsk, Russia; Associate Professor of the Department of Urology and Oncology of the Federal State Budgetary Educational Institution of Higher Education «Bashkir State Medical University» of the Ministry of Health of the Russian Federation, Ufa, Russia; E-Mail: denecer@yandex.ru

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