Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
Departments of Urology, University of Iowa, Iowa City, Iowa.
J Urol. 2019 Feb;201(2):364-370. doi: 10.1016/j.juro.2018.09.051.
The purpose of this multi-institutional study was to compare outcomes of transecting and nontransecting anastomotic bulbar urethroplasty.
We performed a retrospective, multi-institutional review of the records of 352 patients who underwent transecting or nontransecting anastomotic bulbar urethroplasty performed by 1 of 4 reconstructive urologists from September 2003 to March 2017. Study outcomes were urethroplasty success, defined as urethral patency greater than 16Fr on cystoscopy; de novo sexual dysfunction assessed at 6 months, defined as a 5-point or greater change in the SHIM (Sexual Health Inventory for Men) or a patient reported adverse change; and 90-day complications, defined as Clavien 2 or greater. When appropriate, comparisons were made between the transecting and nontransecting cohorts using the Mantel-Cox test, the t-test or the chi-square test.
Of the 352 patients with a mean stricture length of 1.7 cm (range 0.5 to 5) 258 and 94 underwent transecting and nontransecting anastomotic bulbar urethroplasty, respectively. The overall success rate was 94.9% at a mean followup of 64.2 months (range 6 to 170). Of the patients 7.1% experienced a 90-day complication and 11.6% reported sexual dysfunction. When comparing transecting and nontransecting techniques, there was no difference in success (93.8% vs 97.9%, Mantel-Cox test p = 0.18) or postoperative complications (8.1% vs 4.3%, p = 0.25). Patients treated with transecting anastomotic urethroplasty were more likely to report an adverse change in sexual function (14.3% vs 4.3%, p = 0.008). On multivariate analysis only transecting urethroplasty was associated with sexual dysfunction (p = 0.01) while age (p = 0.29), stricture length (p = 0.42), etiology (p = 0.99) and surgeon (p = 0.88) were not.
Anastomotic urethroplasty is a highly effective surgery with relatively minimal associated morbidity. Nontransecting anastomotic urethroplasty compares quite favorably to the transecting technique and likely reduces the risk of associated sexual dysfunction.
本多机构研究的目的是比较横断吻合和非横断吻合球部尿道成形术的结果。
我们对 2003 年 9 月至 2017 年 3 月期间由 4 位重建泌尿科医生中的 1 位进行的横断或非横断吻合球部尿道成形术的 352 例患者的记录进行了回顾性、多机构回顾。研究结果为尿道成形术成功，定义为膀胱镜下尿道通畅大于 16Fr；6 个月时新发性功能障碍，定义为 SHIM（男性性功能健康量表）评分变化 5 分或以上或患者报告不良变化；90 天并发症，定义为 Clavien 2 级或更高。在适当的情况下，使用 Mantel-Cox 检验、t 检验或卡方检验比较横断组和非横断组。
352 例患者的平均狭窄长度为 1.7cm（范围 0.5 至 5），258 例和 94 例行横断和非横断吻合球部尿道成形术，平均随访 64.2 个月（范围 6 至 170）。总体成功率为 94.9%。90 天内并发症发生率为 7.1%，性功能障碍发生率为 11.6%。比较横断和非横断技术，成功率无差异（93.8%比 97.9%，Mantel-Cox 检验 p = 0.18）或术后并发症（8.1%比 4.3%，p = 0.25）。行横断吻合尿道成形术的患者更有可能报告性功能不良变化（14.3%比 4.3%，p = 0.008）。多变量分析仅显示横断尿道成形术与性功能障碍相关（p = 0.01），而年龄（p = 0.29）、狭窄长度（p = 0.42）、病因（p = 0.99）和外科医生（p = 0.88）无关。
吻合尿道成形术是一种非常有效的手术，相关发病率相对较低。非横断吻合尿道成形术与横断技术相当，可能降低相关性功能障碍的风险。
