Spencer Jeffrey, Blakely Stephen, Daugherty Michael, Angulo Javier C, Martins Francisco, Venkatesan Krishnan, Nikolavsky Dmitriy
SUNY Upstate Medical University, Department of Urology, Syracuse, NY.
Departamento Clinico, Facultad de Ciencias Biomedicas y de la Salud, Universidad Europea de Madrid, Laureate Universities, Madrid, Spain; Servicio de Urologia, Hospital Universitario de Getafe, Madrid, Spain.
Urology. 2018 Jan;111:208-213. doi: 10.1016/j.urology.2017.08.029. Epub 2017 Aug 30.
To evaluate clinical and patient-reported urinary and sexual outcomes after a long-segment stricture repair using the 1-sided urethral dissection, penile invagination, and dorsal buccal mucosa graft onlay technique described by Kulkarni et al.
Patients from 4 institutions after single-stage repairs for long-segment urethral strictures (>8 cm) from January 2002 to April 2016 were reviewed. Technique described by Kulkarni et al was used in all cases. Clinical outcomes included uroflowmetry (Qmax) and post-void residuals. Patient-reported outcome measures included International Prostate Symptom Score survey, Sexual Health Inventory for Men, Male Sexual Health Questionnaire, and Global Response Assessment questionnaire to measure voiding, sexual, ejaculatory symptoms, and overall improvement, respectively.
Seventy-three patients with a minimum of 12 months' follow-up were included. The mean age and stricture length were 56 (21-80) years and 13.6 (8-21) cm, respectively. At a mean follow-up of 44 (12-162) months, 9 of 73 (12%) strictures recurred. The mean baseline International Prostate Symptom Score of 23 (7-24) decreased to 10 (1-17) on follow-up (P <.001). Eight of 42 patients (21.4%) reported an increase, and 6 of 42 patients (14.3%) decreased in Sexual Health Inventory for Men following urethroplasty. Ejaculatory function on Male Sexual Health Questionnaire improved after urethroplasty from 8 preoperatively to 11 postoperatively (P <.004). All patients reported improvement after urethroplasty on Global Response Assessment questionnaire. Post-void dribbling and chordee occurred in 45% and 25% of patients, respectively.
Durable patency in most patients is demonstrated in this study. PROMs indicate an improvement in urinary function and moderate effect on sexual function. Transient penile chordee was evident in 25% of patients.
采用库尔卡尼等人描述的单侧尿道游离、阴茎套入和颊黏膜背侧移植覆盖技术，评估长段尿道狭窄修复术后的临床及患者报告的泌尿和性功能结局。
回顾2002年1月至2016年4月期间在4家机构接受长段尿道狭窄（>8 cm）一期修复的患者。所有病例均采用库尔卡尼等人描述的技术。临床结局包括尿流率（最大尿流率）和排尿后残余尿量。患者报告的结局指标包括国际前列腺症状评分调查、男性性健康量表、男性性健康问卷以及总体反应评估问卷，分别用于测量排尿、性功能、射精症状及总体改善情况。
纳入73例至少随访12个月的患者。平均年龄和狭窄长度分别为56（21 - 80）岁和13.6（8 - 21）cm。平均随访44（12 - 162）个月时，73例中有9例（12%）狭窄复发。平均基线国际前列腺症状评分为23（7 - 24），随访时降至10（1 - 17）（P <.001）。尿道成形术后，42例患者中有8例（21.4%）报告男性性健康量表评分增加，42例中有6例（14.3%）评分降低。男性性健康问卷中的射精功能在尿道成形术后从术前的8分改善至术后的11分（P <.004）。所有患者在总体反应评估问卷中均报告尿道成形术后有改善。45%的患者出现排尿后滴沥，25%的患者出现阴茎下弯。
本研究表明大多数患者的尿道保持持久通畅。患者报告结局指标显示排尿功能改善，对性功能有中度影响。25%的患者出现短暂性阴茎下弯。
