MRC Centre for Transplantation, Guy's Hospital, King's College London, London, UK.
Department of Urology, King's College Hospital, London, UK.
World J Urol. 2019 Sep;37(9):1801-1815. doi: 10.1007/s00345-019-02709-7. Epub 2019 Mar 15.
Redo-urethroplasty is a challenge for any genitourethral surgeon, with a number of techniques previously described. This systematic review aims to identify the surgical techniques described in the literature and evaluate the evidence for their effectiveness in managing recurrent urethral strictures.
A systematic review of the MEDLINE and EMBASE databases from 1945 to July 2018 was performed and the urethroplasty procedures were classified according to the site and surgical technique. Primary outcomes included success rates measured via re-stricture rates and the post-op maximum urinary flow rate. Secondary outcomes included complication rates and patient-reported quality of life.
A total of 39 identified studies met the inclusion criteria. Twenty-two studies described the use of excision and primary anastomotic urethroplasty with success rates showing wide variability (58-100%). Success rates reported according to the site of the stricture also varied: bulbar (58-100%) and posterior (69-100%) recurrent strictures. One-stage substitution urethroplasty was described in 25 studies with success rates of 18-100%, with the best outcomes reported for bulbar (58-100%) and hypospadias-related (78.6-82%) strictures. Two-stage substitution urethroplasty was described in 12 studies with the success rates of 20-100%, with the best evidence related to hypospadias-related and posterior urethral strictures. The buccal mucosa graft was the graft source with the best evidence for substitution urethroplasty (18-100%).
Trends of effectiveness were identified for redo-urethroplasty modalities in different locations. However, the current levels of evidence are limited to small observational studies, highlighting the need for further larger prospective data to evaluate different techniques used for recurrent urethral strictures.
对于任何泌尿生殖器外科医生来说，尿道再修复术都是一个挑战，之前已经描述了许多技术。本系统评价旨在确定文献中描述的手术技术，并评估其在治疗复发性尿道狭窄中的有效性证据。
对 1945 年至 2018 年 7 月期间 MEDLINE 和 EMBASE 数据库进行了系统评价，并根据部位和手术技术对尿道修复术进行了分类。主要结局指标包括通过再狭窄率和术后最大尿流率来衡量的成功率。次要结局指标包括并发症发生率和患者报告的生活质量。
共确定了 39 项符合纳入标准的研究。22 项研究描述了采用切除和一期吻合尿道修复术，成功率显示出很大的差异（58-100%）。根据狭窄部位报告的成功率也有所不同：球部（58-100%）和后部（69-100%）复发性狭窄。25 项研究描述了一期替代尿道成形术，成功率为 18-100%，其中球部（58-100%）和与尿道下裂相关的（78.6-82%）狭窄的结果最好。12 项研究描述了二期替代尿道成形术，成功率为 20-100%，其中与尿道下裂相关和后尿道狭窄的证据最好。颊黏膜移植物是替代尿道成形术中证据最好的移植物来源（18-100%）。
在不同部位，尿道再修复术的有效性趋势已经确定。然而，目前的证据水平仅限于小型观察性研究，这突出表明需要进一步开展更大规模的前瞻性数据，以评估用于治疗复发性尿道狭窄的不同技术。
