Original Article

Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome

Abstract

Background: Different arterial segments throughout the vascular system develop similar grades of atherosclerosis concomitantly. Urethral ischemia has been proposed as a cause of urethral stricture. Therefore, we aimed to investigate the relationship between coronary artery disease severity using a SYNTAX score and urethral stricture occurrence after urethral catheterization in patients with non–ST-segment-elevation acute coronary syndrome (ACS).
Methods: This retrospective study consisted of 306 men with urethral catheters that were diagnosed with ACS and underwent coronary angiography between January 2016 and January 2018 in Kars Kafkas University and Osmaniye Government Hospital, Turkey.  Hospital records were reviewed to collect the follow-up data of the patients regarding the occurrence of urethral stricture after urethral catheterization. The study population was divided into 2 groups according to urethral stricture development, and both groups were compared statistically.
Results: SYNTAX scores were significantly higher in patients with urethral stricture than in those without urethral stricture (14.86±7.11 vs. 29.25±9.79; P<0.001). The SYNTAX score (OR=1.27; 95% CI: 1.16–1.39; P<0.001), diabetes, and serum albumin were found to be the independent predictors of urethral stricture. The receiver operating characteristic curve analysis showed that the cutoff value of the SYNTAX score for urethral stricture prediction was greater than 22.5, with 76.7% sensitivity and 85.1% specificity (AUC=0.88, 95% CI: 0.84–0.91; P<0.001).
Conclusion: Coronary artery disease severity graded according to the SYNTAX score is an independent predictor of urethral stricture occurrence in ACS patients with a urethral catheter inserted.

1. Smith TG 3rd. Current management of urethral stricture disease. Indian J Urol 2016;32:27-33.
2. Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol 2007;177:1667-1674.
3. Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology 2005;65:1055-1058.
4. Meddings J, Saint S, Fowler KE, Gaies E, Hickner A, Krein SL, Bernstein SJ. The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA appropriateness method. Ann Intern Med 2015;162(9 Suppl):S1-34.
5. Aoki T. Appropriate use of urinary catheter in acute heart failure patients. Circ J 2018;82:1505-1506.
6. Latini JM, McAninch JW, Brandes SB, Chung JY, Rosenstein D. SIU/ICUD Consultation on urethral strictures: epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries. Urology 2014;83(3 Suppl):S1-7.
7. Abdel-Hakim A, Hassouna M, Teijeira J, Elhilali M. Role of urethral ischemia in the development of urethral strictures after cardiovascular surgery: a preliminary report. J Urol 1984;131:1077-1079.
8. Elhilali MM, Hassouna M, Abdel-Hakim A, Teijeira J. Urethral stricture following cardiovascular surgery: role of urethral ischemia. J Urol 1986;135:275-277.
9. Mundy AR, Andrich DE. Urethral strictures. BJU Int 2011;107:6-26.
10. Abdel-Hakim A, Bernstein J, Teijeira J, Elhilali MM. Urethral stricture after cardiovascular surgery, a retrospective and a prospective study. J Urol 1983;130:1100-1102.
11. Ruutu M, Alfthan O, Heikkinen L, Järvinen A, Konttinen M, Lehtonen T, Merikallio E, Standertskjöld-Nordenstam CG. Unexpected urethral strictures after short-term catheterization in open-heart surgery. Scand J Urol Nephrol 1984;18:9-12.
12. Sutherland PD, Maddern JP, Jose JS, Marshall VR. Urethral stricture after cardiac surgery. Br J Urol 1983;55:413-416.
13. Montorsi P, Ravagnani PM, Galli S, Salonia A, Briganti A, Werba JP, Montorsi F. Association between erectile dysfunction and coronary artery disease: matching the right target with the right test in the right patient. Eur Urol 2006;50:721-731.
14. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155-2165.
15. Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, Mehran R, Dangas G, Lazar D, Sanchez R, Fahy M, Xu K, Stone GW. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. J Am Coll Cardiol 2011; 57: 2389–2397.
16. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Jr, Ganiats TG, Holmes DR, Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ; ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;130:e344-426.
17. Barry MJ, Fowler FJ, Jr, O'Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, Cockett AT. The American Urological Association symptom index for benign prostatic hyperplasia. The measurement committee of the American Urological Association. J Urol 1992;148:1549-1557.
18. Walsh A, Smith JM, Neligan M. Urethral strictures after open heart surgery. Lancet 1982;1:392.
19. Painter MR, Borski AA, Trevino GS, Clark WE, Jr. Urethral reaction to foreign objects. J Urol 1971;106:227-230.
20. Engelbart RH, Bartone FF, Gardner P, Hutson J. Urethral reaction to catheter materials in dogs. Invest Urol 1978;16:55-56.
21. Andrade WS, Oliveira P, Laydner H, Ferreira EJ, Barreto-Filho JA. Severity of erectile dysfunction is highly correlated with the syntax score in patients undergoing coronariography. Int Braz J Urol 2016;42:123-131.
22. Hamur H, Duman H, Keskin E, Inci S, Kucuksu Z, Degirmenci H, Topal E. The relation between erectile dysfunction and extent of coronary artery disease in the patients with stable coronary artery disease. Int J Clin Exp Med 2015;8:21295-21302.
23. Canat L, Cicek G, Atis G, Gurbuz C, Caskurlu T. Is there a relationship between severity of coronary artery disease and severity of erectile dysfunction? Int Braz J Urol 2013;39:465-473.
24. Reriani M, Flammer AJ, Li J, Prasad M, Rihal C, Prasad A, Lennon R, Lerman LO, Lerman A. Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses. Coron Artery Dis 2014;25:552-557.
25. Sullivan ME, Thompson CS, Dashwood MR, Khan MA, Jeremy JY, Morgan RJ, Mikhailidis DP. Nitric oxide and penile erection: is erectile dysfunction another manifestation of vascular disease? Cardiovasc Res 1999;43:658-665.
26. Kumsar S, Sağlam HS, Köse O, Budak S, Adsan O. Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control. Urol Ann 2014;6:321-324.¬¬¬
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IssueVol 15 No 3 (2020): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
Published2020-07-15
DOI https://doi.org/10.18502/jthc.v15i3.4221
Keywords
Acute coronary syndrome Urinary catheterization Urethral stricture Atherosclerosis

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How to Cite
1.
YILDIZ İbrahim, Gokalp F, BURAK C, KARAZINDIYANOGLU S, YILDIZ P, RENGUZOGULLARI I, KARABAG Y, CAGDAS M. Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome. J Tehran Heart Cent. 15(3):113-118.