Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Division of Urology, Department of Surgery, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Urol. 2017 Nov;198(5):1107-1112. doi: 10.1016/j.juro.2017.05.006. Epub 2017 May 5.
We evaluated preoperative risk factors associated with stricture recurrence in a large, homogenous series of bulbar urethroplasties.
We analyzed the records of 596 patients who underwent isolated bulbar urethroplasty at a single center from August 2003 to June 2015. Urethroplasty failure was defined as stricture less than 16Fr identified on cystoscopy with a minimum of 12 months of followup. The potential risk factors examined were patient age, stricture etiology, stricture length, diabetes, smoking, obesity, Charlson comorbidity index, previous endoscopic treatment, previous urethroplasty and type of urethroplasty. Univariate and multivariable Cox regression analysis was used to evaluate potential risk factors and associations.
Average stricture length was 3.9 cm and mean patient age was 44.4 years. Overall urethral patency was 93.3% and mean followup was 65.4 months (range 12 to 149). Previous endoscopic treatment had failed in 88.1% of patients while previous urethroplasty had failed in 10.7%. On multivariate analysis increased stricture length (HR 1.2, 95% CI 1.1-1.3, p = 0.01), increased patient comorbidity (HR 2.4, 95% CI 1.1-5.3, p = 0.03), obesity (HR 2.9, 95% CI 1.3-6.5, p = 0.01) and infectious strictures (HR 3.7, 95% CI 1.3-10.6, p = 0.02) were associated with stricture recurrence. Previous urethroplasty, the number of failed endoscopic procedures, type of urethroplasty and individual comorbidities such as diabetes, smoking and patient age did not affect the recurrent stricture rate.
Although bulbar urethroplasty has a good stricture-free rate, patients with increased stricture length, increased overall comorbidity, obesity and strictures of infectious etiology are at higher risk for failure. These patients at risk should be counseled accordingly and perhaps be followed more closely after urethroplasty.
我们评估了在大型同种异体球部尿道成形术中与狭窄复发相关的术前危险因素。
我们分析了 2003 年 8 月至 2015 年 6 月在单一中心接受单纯球部尿道成形术的 596 例患者的记录。尿道成形术失败定义为在至少 12 个月的随访中通过膀胱镜检查发现狭窄小于 16Fr。检查的潜在危险因素包括患者年龄、狭窄病因、狭窄长度、糖尿病、吸烟、肥胖、Charlson 合并症指数、先前的内镜治疗、先前的尿道成形术和尿道成形术的类型。使用单变量和多变量 Cox 回归分析评估潜在的危险因素和关联。
平均狭窄长度为 3.9cm，平均患者年龄为 44.4 岁。尿道通畅率为 93.3%，平均随访时间为 65.4 个月（12 至 149 个月）。88.1%的患者先前的内镜治疗失败，10.7%的患者先前的尿道成形术失败。多变量分析显示，狭窄长度增加（HR 1.2，95%CI 1.1-1.3，p=0.01）、患者合并症增加（HR 2.4，95%CI 1.1-5.3，p=0.03）、肥胖（HR 2.9，95%CI 1.3-6.5，p=0.01）和感染性狭窄（HR 3.7，95%CI 1.3-10.6，p=0.02）与狭窄复发相关。先前的尿道成形术、内镜治疗失败的次数、尿道成形术的类型以及糖尿病、吸烟和患者年龄等个体合并症并未影响复发性狭窄的发生率。
尽管球部尿道成形术有较好的无狭窄率，但狭窄长度增加、总合并症增加、肥胖和感染性病因的狭窄患者发生失败的风险更高。这些高危患者应相应地接受咨询，并在尿道成形术后可能需要更密切地随访。
