Theisen Katherine, Fuller Thomas W, Bansal Utsav, Reese Jeremy, Lamm Vladimir, Chen Mang, Rusilko Paul
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Urology. 2017 Apr;102:229-233. doi: 10.1016/j.urology.2016.12.003. Epub 2017 Jan 9.
To evaluate the safety and feasibility of same-day anterior urethroplasty at our institution and define predictors of postoperative admission and surgical failure.
We retrospectively reviewed the charts of 118 consecutive anterior urethroplasties performed at a tertiary care center. Data were analyzed to detect predictors of postoperative admission and urethroplasty failure. The 30-day complications and long-term outcomes were compared between same-day and admitted patients.
Ninety-two patients (78%) were discharged on the day of surgery. A penile stricture location compared with a bulbar stricture location (odds ratio: 13.4, P = .009) and having undergone more than 3 prior endoscopic stricture interventions (odds ratio: 10.2, P = .001) were significantly associated with postoperative admission. Patients with a ventral onlay approach were more likely to be discharged home (P = .03), whereas patients with combined repairs were more likely to be admitted (P = .04). Same-day urethroplasty did not increase 30-day postoperative complications, patient emergency room visits, unplanned clinic visits, or phone calls. Success rates did not differ between same-day (89%) and admitted (79%) cohorts, and no individual stricture characteristic was predictive of urethroplasty failure.
Same-day anterior urethroplasty is safe and feasible and could help increase utilization of urethroplasty for urethral stricture disease.
评估我院当日行前尿道成形术的安全性和可行性，并确定术后住院及手术失败的预测因素。
我们回顾性分析了一家三级医疗中心连续进行的118例前尿道成形术病例。分析数据以检测术后住院及尿道成形术失败的预测因素。比较当日出院患者和住院患者的30天并发症及长期预后情况。
92例患者（78%）在手术当日出院。阴茎部狭窄部位与球部狭窄部位相比（比值比：13.4，P = 0.009）以及既往接受过3次以上内镜下狭窄干预（比值比：10.2，P = 0.001）与术后住院显著相关。采用腹侧覆盖法的患者更有可能出院回家（P = 0.03），而采用联合修复的患者更有可能住院（P = 0.04）。当日尿道成形术并未增加术后30天并发症、患者急诊就诊、计划外门诊就诊或电话随访的次数。当日手术组（89%）和住院手术组（79%）的成功率无差异，且没有单个狭窄特征可预测尿道成形术失败。
当日行前尿道成形术安全可行，有助于提高尿道狭窄疾病尿道成形术的利用率。
