Creatinine and hemoglobin/creatinine ratio as predictors of 12-month recurrence after direct visual internal urethrotomy for short-segment (<2 cm) bulbar urethral strictures

Abstract

Background:

Urethral stricture (US) disease frequently recurs after direct visual internal urethrotomy (DVIU). This study investigated the prognostic value of serum creatinine, estimated glomerular filtration rate (eGFR), and the hemoglobin/creatinine (Hgb/Cre) ratio for predicting 12-month recurrence in short-segment bulbar US.

Methods:

A retrospective cohort of 237 patients undergoing DVIU for isolated bulbar US <2 cm between 2012 and 2024 was analyzed. Demographics, comorbidities, laboratory parameters, and uroflowmetry were recorded. Renal function markers (creatinine, eGFR) and Hgb/Cre ratio were evaluated using receiver operating characteristic (ROC) analysis, Kaplan–Meier survival curves, and multivariable logistic regression.

Results:

Recurrence occurred in 103 patients (43.5%) within 12 months (median: 6 months). Patients with recurrence had higher creatinine (1.10 vs 0.99 mg/dL, p < 0.001), lower eGFR (74.0 vs 88.0 mL/min/1.73 m², p < 0.001), and lower Hgb/Cre ratios (12.13 vs 14.28, p = 0.002). Endoscopic surgery–related etiology was strongly associated with recurrence (70.8% vs 47.0%, p = 0.001), whereas age, hemoglobin, Qmax, and PVR showed no significant relationship. In multivariable models, elevated creatinine (OR 3.47, 95% CI 1.82–6.60), reduced Hgb/Cre ratio (OR 0.90, 95% CI 0.85–0.95), and lower eGFR (OR 0.975, 95% CI 0.964–0.987) independently predicted recurrence. Kaplan–Meier analysis demonstrated significantly higher recurrence in patients with creatinine ⩾ 1.02 mg/dL, eGFR ⩽ 80.5 mL/min/1.73 m², and Hgb/Cre ratio ⩽ 13.26.

Conclusions:

Elevated serum creatinine, reduced eGFR, and a lower Hgb/Cre ratio are independent predictors of 12-month recurrence following DVIU for short-segment bulbar US. Demographic and uroflowmetric parameters showed limited predictive value, whereas iatrogenic etiology markedly increased recurrence risk. Incorporating renal function markers into risk stratification may guide patient selection and support timely consideration of urethroplasty or drug-coated balloon dilatation (Optilume) in high-risk individuals. Prospective multicenter studies are warranted.