Department of Urology, Eberhard-Karls University, Tuebingen, Germany.
Urology. 2011 Sep;78(3):696-700. doi: 10.1016/j.urology.2011.04.051. Epub 2011 Jul 13.
To evaluate the efficacy of sonourethrography (SUG) in combination with voiding pattern analysis to determine success after oral mucosa graft (OMG) urethroplasty. OMG urethroplasty is a standard treatment for men with recurrent urethral stricture. Because of its performance, the optimum follow-up algorithm remains controversial.
Forty-nine patients (mean age 51 years) who underwent OMG urethroplasty were retrospectively identified. All men were subjected to a validated voiding questionnaire (International Prostate Symptom Score [IPSS]), SUG, uroflowmetry, and residual urine measurement. The predictive value was analyzed with regard to stricture recurrence or patency as well as to urethral diameter. Retrograde urethrography was done to confirm the diagnosis.
Strictures were bulbar in 39, penile in 4, and combined in 6 patients. Mean stricture length was 3.8 cm (range 1-10). Mean follow-up after surgery was 35 (range 15-70) months. SUG showed a mean diameter of 7.6 mm for bulbar grafts and 4.6 mm for penile grafts. Stricture recurrence was seen in 4 (8%) patients, yielding a significantly lower urethral width of 2.3 mm (P<.005). Retrograde urethrography confirmed the patency status in all. The average maximum flow rate after successful repair was 36.6 mL/s, whereas those with recurrent strictures showed rates of 11.2 (P<.03). Similar results were achieved for residual urine (P<.05). IPSS values increased from 5.1 to 12.5 in patients with recurrence (P<.01).
An algorithm consisting of SUG, uroflowmetry, residual urine and IPSS assessment reliably identifies stricture recurrence. Routine retrograde urethrography may therefore be unnecessary in the follow-up of OMG urethroplasty.
评估声尿动力学（SUG）联合排尿模式分析在确定口腔黏膜移植物（OMG）尿道成形术后成功的效果。OMG 尿道成形术是治疗复发性尿道狭窄男性的标准治疗方法。由于其性能，最佳的随访算法仍存在争议。
回顾性确定了 49 例（平均年龄 51 岁）接受 OMG 尿道成形术的患者。所有男性均接受了经过验证的排尿问卷（国际前列腺症状评分 [IPSS]）、SUG、尿流率和残余尿测量。分析了预测值与狭窄复发或通畅性以及尿道直径的关系。逆行尿道造影用于确诊。
狭窄位于球部 39 例，阴茎部 4 例，两者均有 6 例。平均狭窄长度为 3.8 厘米（范围 1-10）。术后平均随访 35 个月（范围 15-70）。SUG 显示球部移植物的平均直径为 7.6 毫米，阴茎部移植物的平均直径为 4.6 毫米。4 例（8%）患者出现狭窄复发，尿道宽度明显变窄至 2.3 毫米（P<.005）。逆行尿道造影确认了所有患者的通畅状态。成功修复后的平均最大流速为 36.6 毫升/秒，而出现再狭窄的患者流速为 11.2 毫升/秒（P<.03）。残余尿也有类似结果（P<.05）。复发患者的 IPSS 值从 5.1 增加到 12.5（P<.01）。
由 SUG、尿流率、残余尿和 IPSS 评估组成的算法可可靠地识别狭窄复发。因此，在 OMG 尿道成形术的随访中，常规逆行尿道造影可能不必要。
