The Impact of Hypogonadism on Surgical Outcomes Following Primary Urethroplasty: Analysis of a Large Multi-institutional Database

OBJECTIVES:To compare surgical outcomes among a cohort of eugonadal and hypogonadal patients undergoing primary urethroplasty (UP). METHODS:A retrospective cohort study was conducted using TriNetX between 2008-2023. Patients that were eugonadal and hypogonadal (symptoms plus testosterone <300ng/dL) prior to UP were compared. A subgroup analysis of hypogonadal patients was performed to compare those with testosterone replacement therapy (TRT) vs. TRT-naïve prior to UP. Propensity-score matching was used to adjust for differences in comorbidities. Outcomes were 5-year revision rates and revision-free survival (RFS) for endoscopic revision and redo UP following primary UP. RESULTS:We identified 12,556 eugonadal and 488 hypogonadal patients (153 TRT+, 335 TRT-) undergoing UP. Median age at UP and follow-up was 55 years and 5 years, respectively. After propensity-score matching, we compared 477 eugonadal and 477 hypogonadal patients. Hypogonadal patients had a statistically significantly higher 5-year redo UP rate (11% vs. 6%, RR 1.5 [95%CI, 1.2-2.2];p=0.01) when compared to eugonadal patients however there was no difference in 5-year rates of endoscopic revision (11% vs. 11%, RR 1.0 [95%CI, 0.7-1.5];p=1.0). We observed no difference in 5-year RFS time for endoscopic revision or redo UP between groups. Hypogonadal patients treated with TRT had a significantly higher 5-year redo UP rate (15% vs. 7%, RR 1.8 [95%CI, 1.1-3.3];p=0.02) compared to hypogonadal patients that were TRT-naïve prior to UP. There was no difference in rates of endoscopic revision (14% vs. 10%, RR 1.3 [95%CI, 0.7-2.4];p=0.2) between subgroups. CONCLUSIONS:Pre-existing hypogonadism may modestly adversely affect surgical outcomes following primary urethroplasty based on data from a large, retrospective cohort study.