Evans Patrick, Keihani Sorena, Breyer Benjamin N, Erickson Bradley A, Hotaling James M, Lenherr Sara M, Myers Jeremy B
Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
Urology. 2018 Jul;117:156-162. doi: 10.1016/j.urology.2018.02.046. Epub 2018 Apr 12.
To understand the prevalence of chronic perineal pain, activity limitations, and patient satisfaction after urethroplasty.
From 2014 to 2016, we prospectively enrolled men undergoing urethroplasty for bulbar urethral strictures. Patients, before and after surgery, completed questions from the Core Lower Urinary Tract Symptom Score assessing pain frequency in the bladder and penis or urethra, as well as nonvalidated questions assessing perineal pain. Overall satisfaction with their current urinary condition and pain-related activity limitations at home, work, or during exercise were also measured. Patients with <3 months of follow-up were excluded. Pre-and postoperative scores were compared using the Wilcoxon signed-rank test.
Thirty-five men were included in the study. Mean age and body mass index were 44.6 years and 30.9 kg/m, respectively. Urethroplasties were anastomotic in 24 (69%) and were single-stage buccal graft substitution in 11 (31%). Median follow-up after surgery was 483 days (range: 90-810 days). A total of 10 patients (29%) reported worsening perineal pain intensity after surgery, whereas 8 (23%) reported improvement and 17 (48%) reported no change. Overall, pain frequency in the bladder, penis or urethra, and perineum improved. Home and exercise pain-related activity restrictions improved significantly after surgery. Satisfaction with current urinary condition also improved with 91% reporting feeling "delighted," "pleased," or "mostly satisfied" with their current condition.
Patients are highly satisfied with their urinary condition after urethroplasty. Pain frequency in the bladder and the urethra significantly improves after urethroplasty; however, perineal pain intensity can worsen and become chronic after surgery in some patients.
了解尿道成形术后慢性会阴部疼痛、活动受限情况及患者满意度。
2014年至2016年，我们前瞻性纳入了因球部尿道狭窄接受尿道成形术的男性患者。患者在手术前后完成了来自下尿路症状核心评分量表的问题，以评估膀胱、阴茎或尿道的疼痛频率，以及评估会阴部疼痛的未经验证的问题。还测量了患者对其当前排尿状况的总体满意度，以及在家中、工作或运动期间与疼痛相关的活动受限情况。随访时间不足3个月的患者被排除。采用Wilcoxon符号秩检验比较术前和术后评分。
35名男性纳入研究。平均年龄和体重指数分别为44.6岁和30.9kg/m²。24例（69%）行吻合性尿道成形术，11例（31%）行单阶段颊黏膜移植替代术。术后中位随访时间为483天（范围：90 - 810天）。共有10例患者（29%）报告术后会阴部疼痛强度加重，8例（23%）报告有所改善，17例（48%）报告无变化。总体而言，膀胱、阴茎或尿道以及会阴部的疼痛频率有所改善。术后在家中和运动时与疼痛相关的活动限制显著改善。对当前排尿状况的满意度也有所提高，91%的患者报告对其当前状况感到“欣喜”“满意”或“基本满意”。
患者对尿道成形术后的排尿状况高度满意。尿道成形术后膀胱和尿道的疼痛频率显著改善；然而，部分患者术后会阴部疼痛强度可能加重并变为慢性疼痛。
