Division of Urology, Washington University , St. Louis , Missouri.
Departments of Urology, University of California-San Francisco , San Francisco.
J Urol. 2019 May;201(5):956-961. doi: 10.1097/JU.0000000000000027.
Perineal urethrostomy is a viable option for many complex urethral strictures. However, to our knowledge no comparison with anterior urethroplasty regarding patient reported outcome measures has been published. We compared these groups using a large multi-institution database.
We performed a retrospective study of anterior urethroplasty in the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database. The anterior urethroplasty cohort was defined by long strictures greater than 6 cm. We compared demographic, clinical, urinary and sexual characteristics using validated patient reported outcome measures between patients treated with long stricture anterior urethroplasty and those who underwent perineal urethrostomy.
Of the 131 patients 92 treated with long stricture anterior urethroplasty and 39 treated with perineal urethrostomy met study inclusion criteria. The cumulative incidence of failure at 2 years was 30.2% (95% CI 18.3-47.3) for long stricture anterior urethroplasty and 14.5% (95% CI 4.8-39.1) for perineal urethrostomy (p = 0.09). Compared to baseline metrics, patients who underwent long stricture anterior urethroplasty and perineal urethrostomy had similar improvements in urinary function and stable sexual function after surgery.
Patients reported improvement in urinary function after perineal urethrostomy with no deleterious effect on sexual function. These patient reported outcome measures were comparable to those of long stricture anterior urethroplasty. Perineal urethrostomy failure rates were similar to those of long stricture anterior urethroplasty.
对于许多复杂的尿道狭窄，会阴尿道造口术是一种可行的选择。然而，据我们所知，尚无关于患者报告的结果测量与前尿道成形术的比较发表。我们使用大型多机构数据库对这些组进行了比较。
我们对 TURNS（创伤和泌尿科重建外科医生网络）数据库中的前尿道成形术进行了回顾性研究。前尿道成形术队列由大于 6 厘米的长段狭窄定义。我们使用经过验证的患者报告的结果测量方法，比较了接受长段狭窄前尿道成形术和会阴尿道造口术的患者之间的人口统计学，临床，尿液和性功能特征。
在 131 名患者中，有 92 名接受长段狭窄前尿道成形术治疗，有 39 名接受会阴尿道造口术治疗，符合研究纳入标准。长段狭窄前尿道成形术的 2 年累积失败率为 30.2％（95％CI 18.3-47.3），会阴尿道造口术为 14.5％（95％CI 4.8-39.1）（p = 0.09）。与基线指标相比，接受长段狭窄前尿道成形术和会阴尿道造口术的患者在手术后尿路功能均有改善，性功能稳定。
会阴尿道造口术后，患者报告尿路功能改善，且对性功能无不良影响。这些患者报告的结果测量与长段狭窄前尿道成形术相当。会阴尿道造口术的失败率与长段狭窄前尿道成形术相似。
