Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. L.Kluth@ uke.de
J Endourol. 2013 Jul;27(7):925-9. doi: 10.1089/end.2013.0029. Epub 2013 May 9.
Only few comparative reports about different urethroplasties have been published, addressing success rate (SR), adverse events (AE), and quality of life (QoL). Our purpose was to evaluate SR, AE, and QoL in a contemporary cohort of patients undergoing urethroplasty in the short-term follow-up (FU).
Between December 2008 and June 2010, 205 patients underwent urethroplasty for anterior urethral strictures at our institution. A standardized questionnaire was sent to all patients. The primary end point was SR. Secondary end points were AE and QoL. To assess the risk of SR, the Kaplan-Meier method and log-rank test were used. To assess risk factors for urethral stricture recurrence (SRec), univariable Cox regression analysis was used.
Overall, 140 (68%) patients responded to our questionnaire and were used for analysis. Of these 9%, 85%, and 6% were treated by excision and primary anastomosis (EPA), buccal mucosa graft urethroplasty (BMGU), and mesh graft urethroplasty (MGU), respectively. At 10 months of FU, SR was 87.5%. SRs of EPA, BMGU, and MGU were 100% (n=13/13), 85.7% (n=102/119), and 87.5% (n=7/8), with no significant differences between the groups. In univariable analysis, ≥ 2 vs 1 previous urethroplasties showed a trend toward a reduced SR (hazard risk 2.95; P=0.057). Streaking the urethra (P=0.024) and penile curvature (P=0.026) were significantly more often associated with MGU compared with EPA and BMGU. Postoperative total median (mean) scores were 3.5 (4.8) for the International Consultation on Incontinence Questionnaire Male lower urinary tract symptoms, 15 (15.2) for the International Index of Erectile Function, and 80 (73) for EuroQol visual analogue score; there was no difference between urethroplasty types.
In the short-term FU, urethroplasty demonstrates an excellent SR. Specific SRs of EPA, BMGU, and MGU seem comparable. Despite significant differences in AE, patient reported QoL is high with no difference between the applied techniques.
仅有少数关于不同尿道成形术的比较报告，涉及成功率（SR）、不良事件（AE）和生活质量（QoL）。我们的目的是评估接受尿道成形术患者的短期随访（FU）中的 SR、AE 和 QoL。
2008 年 12 月至 2010 年 6 月，我们机构为 205 例前尿道狭窄患者进行了尿道成形术。向所有患者发送了标准化问卷。主要终点是 SR。次要终点是 AE 和 QoL。为评估 SR 的风险，使用 Kaplan-Meier 方法和对数秩检验。为评估尿道狭窄复发（SRec）的危险因素，使用单变量 Cox 回归分析。
总体而言，140 名（68%）患者对我们的问卷做出了回应并进行了分析。其中，9%、85%和 6%分别接受了切除和一期吻合术（EPA）、颊黏膜移植物尿道成形术（BMGU）和网片移植物尿道成形术（MGU）治疗。在 FU 10 个月时，SR 为 87.5%。EPA、BMGU 和 MGU 的 SR 分别为 100%（n=13/13）、85.7%（n=102/119）和 87.5%（n=7/8），各组之间无显著差异。在单变量分析中，≥2 次 vs 1 次既往尿道成形术显示 SR 降低的趋势（风险比 2.95；P=0.057）。与 EPA 和 BMGU 相比，MGU 更常出现尿道划线（P=0.024）和阴茎弯曲（P=0.026）。国际尿控协会男性下尿路症状问卷男性下尿路症状的术后总中位数（平均）评分分别为 3.5（4.8）、国际勃起功能指数为 15（15.2）、欧洲生活质量量表视觉模拟评分 80（73）；尿道成形术类型之间无差异。
在短期 FU 中，尿道成形术具有出色的 SR。EPA、BMGU 和 MGU 的特定 SR 似乎相当。尽管 AE 存在显著差异，但患者报告的 QoL 较高，应用技术之间无差异。
