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Effect of Urethroplasty on Anxiety and Depression
Jared P. Schober, MD1, Kristian D. Stensland, MD1, Benjamin N. Breyer, MD2, Bradley A. Erickson, MD3, Jeremy B. Myers, MD4, Brian B. Voelzke, MD5, Jill C. Buckley, MD6, Alex J. Vanni, MD1.
1Lahey Hospital and Medical Center, Burlington, MA, USA, 2University of California, San Francisco, CA, USA, 3University of Iowa, Iowa City, IA, USA, 4University of Utah, Salt Lake City, UT, USA, 5University of Washington, Seattle, WA, USA, 6University of California, San Diego, CA, USA.

Introduction and Objective: To our knowledge, anxiety and depression (AD) in patients with urethral stricture disease (USD) and the impact of urethroplasty has never been explored. We hypothesize that patients with USD undergoing urethroplasty will have an improvement in their AD.
Methods: Patients undergoing anterior urethroplasty were retrospectively reviewed from a multi-institutional reconstructive urology database. Patient demographics and stricture characteristics were recorded. Pre- and postoperative AD was recorded using the validated Eq-5d Questionnaire. Patient evaluation of overall health (scale of 1-100 with 100 representing perfect health) and sexual function (International Index of Erectile Function: IIEF) was performed. Stricture recurrence was defined as the need for subsequent procedure. Patients were excluded if they were missing pre- or post-operative data. Outcomes were analyzed with chi-square, Fisher’s exact, and Student’s t-tests or ANOVA as appropriate.
Results: 298 patients met inclusion criteria with median post-op survey completion follow-up time of 4.2 months. Of the 298 patients, 86 (29%) reported preoperative AD. This group was found to have a higher rate of marijuana use, worse preop IIEF score (17.5 vs 19.6, p=0.01), and lower image of overall health (66 vs. 79, p=<0.001). USD etiology was not a risk factor for pre-operative AD. Improvement or resolution of AD was experienced by 48 out of 86 patients (56%). These patients reported a significantly more optimistic preop image of overall health compared to those who had new or worsened AD (72 vs. 58, p=0.001). New-onset AD was reported in 21 patients (10%). New-onset AD patients were older (54 vs. 46 years, p=0.03) and had a lower preop image of overall health compared to patients with existing AD (64 vs. 80, p=0.002). New-onset AD patients had a decreased postop max flow rate compared to patients who did not have new onset AD (16 ml/sec vs 25 ml/sec; p=0.01). Three patients with AD (4%) had a worsening of their AD. Stricture recurrence occurred in 8 patients (2.7%) and had no effect on the development, improvement, or resolution of AD.
Conclusions: 56% of patients with preoperative AD reported improvement or resolution after urethroplasty. Although new onset AD was rare, these patients had a significantly lower postoperative max flow rate, possibly representing a group with a perceived suboptimal surgical outcome. Items within a USD specific questionnaire that assess AD will further enable surgeons to better understand the interplay between USD and AD.


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