Liu Joceline S, Han Justin, Said Mohammed, Hofer Matthias D, Fuchs Amanda, Ballek Nathaniel, Gonzalez Chris M
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Urology. 2015 Jan;85(1):258-62. doi: 10.1016/j.urology.2014.08.055.
To report the long-term outcomes of urethroplasty using abdominal wall skin (AWS) grafts. Men with long-segment strictures, prior urethroplasty, and lichen sclerosus (LS) pose challenges in surgical management, including the choice of graft tissue for urethral reconstruction. AWS grafts are an alternative when buccal mucosa or penile grafts are not feasible or chosen by the patient.
We retrospectively reviewed 238 patients who underwent urethroplasty (2000-2010) with at least 1 year of follow-up. Demographics, etiology, comorbidities, prior procedures, and surgical technique were analyzed for correlation with recurrence.
Mean age was 42.9 years (range, 15-79 years), mean stricture length 5.6 cm (1-24 cm), and median follow-up of 59.3 months (12.5-147 months). A total of 58.4% patients had prior intervention, of which 15 patients (6.3%) had urethroplasty and 41 patients (17.2%) had hypospadias repair. Twenty-six patients (10.9%) underwent urethroplasty with AWS graft, whereas 107 (45.0%) and 12 (5.0%) patients were augmented with buccal mucosa or genital skin. Sixty-six patients (27.7%) had stricture recurrence at a mean of 34.5 months (range, 1.87-87.1 months). On univariate analysis, patients with AWS graft had longer strictures (P = .0001), were more likely to have LS (P = .0002), prior urethroplasty (P = .007), and recurrence (P = .002). On multivariate analysis, prior urethroplasty (odds ratio [OR], 5.3; P = .009), diabetes (OR, 2.6; P = .04), and LS (OR, 2.8; P = .05) were significantly associated with recurrence, whereas AWS graft was not (OR, 2.0; P = .28).
AWS grafts are an alternative tissue source for urethral stricture, but may be associated with greater risk of recurrence. This may be secondary to patient selection, with this population often having other risk factors for recurrence.
报告使用腹壁皮肤（AWS）移植物进行尿道成形术的长期疗效。患有长段狭窄、既往接受过尿道成形术以及患有硬化性苔藓（LS）的男性在手术治疗中面临挑战，包括尿道重建移植物组织的选择。当颊黏膜或阴茎移植物不可行或患者不选择时，AWS移植物是一种替代选择。
我们回顾性分析了238例在2000年至2010年间接受尿道成形术且随访至少1年的患者。分析了人口统计学、病因、合并症、既往手术及手术技术与复发的相关性。
平均年龄42.9岁（范围15 - 79岁），平均狭窄长度5.6 cm（1 - 24 cm），中位随访时间59.3个月（12.5 - 147个月）。共有58.4%的患者曾接受过干预，其中15例（6.3%）接受过尿道成形术，41例（17.2%）接受过尿道下裂修复术。26例（10.9%）患者使用AWS移植物进行尿道成形术，而107例（4%）和12例（5.0%）患者分别使用颊黏膜或生殖器皮肤进行修复。66例（27.7%）患者出现狭窄复发，平均复发时间为34.5个月（范围1.87 - 87.1个月）。单因素分析显示，使用AWS移植物的患者狭窄段更长（P = 0.0001），更易患LS（P = 0.0002）、既往接受过尿道成形术（P = 0.007）及复发（P = 0.002）。多因素分析显示，既往尿道成形术（优势比[OR]，5.3；P = 0.009）、糖尿病（OR，2.6；P = 0.04）和LS（OR，2.8；P = 0.05）与复发显著相关，而AWS移植物与复发无关（OR，2.0；P = 0.28）。
AWS移植物是尿道狭窄的一种替代组织来源，但可能与更高的复发风险相关。这可能是由于患者选择所致，该人群通常存在其他复发风险因素。
