Department of Urology, University of California, San Francisco, San Francisco, California 94117, USA.
J Urol. 2010 Feb;183(2):613-7. doi: 10.1016/j.juro.2009.10.018. Epub 2009 Dec 16.
We studied the patient risk factors that promote urethroplasty failure.
Records of patients who underwent urethroplasty at the University of California, San Francisco Medical Center between 1995 and 2004 were reviewed. Cox proportional hazards regression analysis was used to identify multivariate predictors of urethroplasty outcome.
Between 1995 and 2004, 443 patients of 495 who underwent urethroplasty had complete comorbidity data and were included in analysis. Median patient age was 41 years (range 18 to 90). Median followup was 5.8 years (range 1 month to 10 years). Stricture recurred in 93 patients (21%). Primary estimated stricture-free survival at 1, 3 and 5 years was 88%, 82% and 79%. After multivariate analysis smoking (HR 1.8, 95% CI 1.0-3.1, p = 0.05), prior direct vision internal urethrotomy (HR 1.7, 95% CI 1.0-3.0, p = 0.04) and prior urethroplasty (HR 1.8, 95% CI 1.1-3.1, p = 0.03) were predictive of treatment failure. On multivariate analysis diabetes mellitus showed a trend toward prediction of urethroplasty failure (HR 2.0, 95% CI 0.8-4.9, p = 0.14).
Length of urethral stricture (greater than 4 cm), prior urethroplasty and failed endoscopic therapy are predictive of failure after urethroplasty. Smoking and diabetes mellitus also may predict failure potentially secondary to microvascular damage.
我们研究了促进尿道成形术失败的患者风险因素。
回顾了 1995 年至 2004 年期间在加利福尼亚大学旧金山医学中心接受尿道成形术的患者的记录。使用 Cox 比例风险回归分析确定尿道成形术结果的多变量预测因素。
1995 年至 2004 年，495 例接受尿道成形术的患者中有 443 例具有完整的合并症数据并纳入分析。患者中位年龄为 41 岁（范围 18 至 90 岁）。中位随访时间为 5.8 年（范围 1 个月至 10 年）。93 例患者（21%）出现吻合口狭窄复发。1、3 和 5 年的原发性估计无狭窄生存率分别为 88%、82%和 79%。多变量分析显示，吸烟（HR 1.8，95%CI 1.0-3.1，p=0.05）、既往直接视线下尿道内切开术（HR 1.7，95%CI 1.0-3.0，p=0.04）和既往尿道成形术（HR 1.8，95%CI 1.1-3.1，p=0.03）与治疗失败相关。多变量分析显示，糖尿病与尿道成形术失败有一定的相关性（HR 2.0，95%CI 0.8-4.9，p=0.14）。
尿道狭窄长度（大于 4cm）、既往尿道成形术和内镜治疗失败是尿道成形术后失败的预测因素。吸烟和糖尿病也可能潜在地与微血管损伤有关，从而预测失败。
