Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Department of Urology, University of Washington, Seattle, Washington.
J Urol. 2016 Aug;196(2):453-61. doi: 10.1016/j.juro.2016.01.117. Epub 2016 Feb 18.
Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.
Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.
At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07-11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05-2.77 and OR 2.74, 95% CI 1.12-6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07-11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction.
Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.
尿道成形术后的主观成功指标在术后监测中变得越来越有价值。我们通过客观指标来检查尿道成形术后患者报告的满意度，以此作为成功的替代指标。
年龄在 18 岁或以上，患有尿道狭窄并接受尿道成形术的男性患者被前瞻性地纳入一项纵向、多机构尿道成形术结局数据库。术前和术后评估包括评估下尿路症状、疼痛、满意度和性功能的问卷。进行了控制狭窄复发（定义为无法用软式膀胱镜通过重建的尿道）的分析，以确定不满意的独立预测因素。
在平均 14 个月的随访中，我们发现 433 例患者中有 89.4%的患者对整体术后满意度高，82.8%的患者会再次选择手术。经膀胱镜检查发现有复发的男性更有可能报告不满意（OR 4.96，95%CI 2.07-11.90），报告不满意的男性尿流率测量值明显更差（p 均<0.02）。在控制复发的情况下，多变量分析显示，尿道和膀胱疼痛（OR 1.71，95%CI 1.05-2.77 和 OR 2.74，95%CI 1.12-6.69）、术后性功能下降（OR 4.36，95%CI 2.07-11.90）和持续存在的下尿路症状（如排尿困难 OR 3.23，1.74-6.01）是不满意的独立预测因素。
尿道成形术后的整体满意度高，传统的手术成功指标与满意度强烈相关。然而，独立于重建尿道的解剖外观，术后疼痛、性功能障碍和持续存在的下尿路症状是患者不满意的预测因素。
