Jarry L, Ravery V, Daché A, Hermieu J-F, Egrot C, Ouzaid I
Service d'urologie, hôpital Bichat Claude Bernard, AP-HP, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France.
Service d'urologie, hôpital Bichat Claude Bernard, AP-HP, université Paris-Diderot, 46, rue Henri-Huchard, 75018 Paris, France.
Prog Urol. 2017 Mar;27(3):184-189. doi: 10.1016/j.purol.2016.12.013. Epub 2017 Mar 1.
Excision and primary anastomosis is a common treatment of the short urethral posterior strictures. Strictures can be associated to pelvic bone fractures, endourological procedure (iatrogenic) or idiopathic. Whether outcomes are different with respect to etiology is still under reported. Herein, we aimed to explore the impact of etiology on care pathway and management of patients treated with excision and primary anastomosis for urethral strictures.
Between January 2004 and December 2015, 97 patients were referred and treated with excision and primary anastomosis for a short urethral stricture. Data were extracted from a single institutional registry and retrospectively analyzed. Patients were sorted into 3 groups with respect to the etiology: pelvic bone fracture (n=23), iatrogenic (n=24) and idiopathic (n=50). Preoperative patient's and stricture characteristics as well as postoperative outcomes of the three groups were compared using Student or Chi tests as appropriate. Specifically, recurrence rate and time to first recurrence was analyzed according to a Cox proportional hazard model.
Patients with strictures caused by pelvic bone fracture were younger (P<0.001), more likely to have a suprapubic catheter (P=0.007), and no attempted procedures before the referral (P<0.001). Strictures length and maximum flowmetry were similar in all groups. Postoperatively, 90-d complications and flowmetry were similar in both groups. After a mean follow-up of 25±24 (range: 1-102) months, 27 (27.8 %) patients recurred. According to our model, etiology did not seem to impact overall recurrence rate. However, when the subgroup of patients with recurrence were analyzed, strictures associated with pelvic bone seemed to recur faster than the 2 remaining groups.
With some limitations of due to the population size and the retrospective design of the analysis, etiology impacted care pathway in terms of referral and initial management of patients treated with excision and primary anastomosis for a short urethral posterior stricture. However, recurrence rate and mid-term outcomes seem less impacted.
切除并一期吻合术是治疗短段尿道后狭窄的常用方法。狭窄可能与骨盆骨折、腔内泌尿外科手术（医源性）或特发性因素有关。病因不同其治疗结果是否存在差异仍鲜有报道。在此，我们旨在探讨病因对接受尿道狭窄切除并一期吻合术患者的治疗路径及管理的影响。
2004年1月至2015年12月期间，97例患者因短段尿道狭窄接受了切除并一期吻合术治疗。数据从单一机构登记处提取并进行回顾性分析。根据病因将患者分为3组：骨盆骨折组（n = 23）、医源性组（n = 24）和特发性组（n = 50）。根据情况使用学生检验或卡方检验比较三组患者术前的患者及狭窄特征以及术后结果。具体而言，根据Cox比例风险模型分析复发率及首次复发时间。
骨盆骨折导致狭窄的患者更年轻（P < 0.001），更有可能留置耻骨上导尿管（P = 0.007），且在转诊前未尝试过其他治疗方法（P < 0.001）。所有组的狭窄长度和最大尿流率相似。术后，两组的90天并发症及尿流率相似。平均随访25±24（范围：1 - 102）个月后，27例（27.8%）患者复发。根据我们的模型，病因似乎并未影响总体复发率。然而，对复发患者亚组进行分析时，与骨盆骨折相关的狭窄似乎比其余两组复发更快。
由于样本量及分析的回顾性设计存在一定局限性，病因在接受短段尿道后狭窄切除并一期吻合术患者的转诊及初始管理方面影响治疗路径。然而，复发率及中期结果似乎受影响较小。
4级
