Wang Lin, Lv Xiangguo, Jin Chongrui, Guo Hailin, Shu Huiquan, Fu Qiang, Sa Yinglong
Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China; Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Urology and Andrology, Shanghai Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Urology. 2018 Feb;112:186-190. doi: 10.1016/j.urology.2017.09.004. Epub 2017 Sep 21.
To develop a standardized PU-score (posterior urethral stenosis score), with the goal of using this scoring system as a preliminary predictor of surgical complexity and prognosis of posterior urethral stenosis.
We retrospectively reviewed records of all patients who underwent posterior urethral surgery at our institution from 2013 to 2015. The PU-score is based on 5 components, namely etiology (1 or 2 points), location (1-3 points), length (1-3 points), urethral fistula (1 or 2 points), and posterior urethral false passage (1 point). We calculated the score of all patients and analyzed its association with surgical complexity, stenosis recurrence, intraoperative blood loss, erectile dysfunction, and urinary incontinence.
There were 144 patients who underwent low complexity urethral surgery (direct vision internal urethrotomy, anastomosis with or without crural separation) with a mean score of 5.1 points, whereas 143 underwent high complexity urethroplasty (anastomosis with inferior pubectomy or urethrorectal fistula repair, perineal or scrotum skin flap urethroplasty, bladder flap urethroplasty) with a mean score of 6.9 points. The increase of PU-score was predictive of higher surgical complexity (P = .000), higher recurrence (P = .002), more intraoperative blood loss (P = .000), and decrease of preoperative (P = .037) or postoperative erectile function (P = .047). However, no association was observed between PU-score and urinary incontinence (P = .213).
The PU-score is a novel and meaningful scoring system that describes the essential factors in determining the complexity and prognosis for posterior urethral stenosis.
制定标准化的PU评分（后尿道狭窄评分），旨在将该评分系统用作后尿道狭窄手术复杂性及预后的初步预测指标。
我们回顾性分析了2013年至2015年在本机构接受后尿道手术的所有患者的记录。PU评分基于5个要素，即病因（1或2分）、位置（1 - 3分）、长度（1 - 3分）、尿道瘘（1或2分）以及后尿道假道（1分）。我们计算了所有患者的评分，并分析其与手术复杂性、狭窄复发、术中失血、勃起功能障碍及尿失禁的相关性。
144例患者接受了低复杂性尿道手术（直视下尿道内切开术、有或无阴茎脚分离的吻合术），平均评分为5.1分；而143例患者接受了高复杂性尿道成形术（耻骨下切除术或尿道直肠瘘修补术、会阴或阴囊皮瓣尿道成形术、膀胱皮瓣尿道成形术），平均评分为6.9分。PU评分的增加预示着更高的手术复杂性（P = 0.000）、更高的复发率（P = 0.002）、更多的术中失血（P = 0.000）以及术前（P = 0.037）或术后勃起功能的降低（P = 0.047）。然而，未观察到PU评分与尿失禁之间存在关联（P = 0.213）。
PU评分是一种新颖且有意义的评分系统，它描述了决定后尿道狭窄复杂性及预后的关键因素。
