University of California, Irvine, CA.
University of Oklahoma, College of Medicine, OK.
Urology. 2019 Aug;130:162-166. doi: 10.1016/j.urology.2019.02.042. Epub 2019 Apr 19.
To report success and patient reported urinary and sexual outcomes of patients who underwent anastomotic urethroplasty and dorsal buccal onlay urethroplasty.
Patients who underwent primary transecting anastomotic or dorsal buccal onlay urethroplasty for bulbar strictures at our institution between 1998 and 2015 were analyzed. Patients who had a prior urethroplasty, involvement of a different portion of the urethra, or a diagnosis of lichen sclerosis (LS) or hypospadias were excluded. Outcomes were assessed by cystoscopy at 4 months, validated questionnaires assessing urinary, erectile, and ejaculatory function at the time of their most recent assessment.
A total of 40 and 139 patients were included in the dorsal buccal and anastomotic groups, respectively. Wide patency at 4-month cystoscopy was 97.5% and 100% (P= .06) and the long-term success was 95% and 99.3% (P= .06) with a mean follow-up of 51.4 and 63.3 months. Patient reported outcomes were similar with 2 exceptions: postvoid dribbling was reported more often in the onlay group (28.1% vs 8.3%, P< .0001), and tethering with erections in the anastomotic group (23.4% vs 3.1%, P= .008). Ninety-eight percent of patients in the anastomotic group and 91% in the dorsal buccal onlay group would choose their surgery again (P= .07).
Both anastomotic urethroplasty and dorsal onlay graft are associated with high success with comparable satisfaction. Patient reported outcome measures were similar regardless of approach, despite inherent differences in stricture length. Our data indicates that anastomotic urethroplasty should not be avoided due to concerns of sexual side effects.
报告吻合口尿道成形术和背侧颊黏膜游离移植尿道成形术患者的手术成功率和患者报告的尿控及性功能结果。
分析了 1998 年至 2015 年间我院因球部狭窄行初次吻合口或背侧颊黏膜游离移植尿道成形术的患者。排除了有先前尿道成形术史、尿道其他部位受累、或诊断为硬化性苔藓（LS）或尿道下裂的患者。通过术后 4 个月的膀胱镜检查、最近评估时使用的评估尿控、勃起和射精功能的有效问卷评估结局。
背侧颊黏膜组和吻合口组分别纳入了 40 例和 139 例患者。术后 4 个月膀胱镜检查时，尿道通畅率分别为 97.5%和 100%（P=.06），长期成功率分别为 95%和 99.3%（P=.06），平均随访时间分别为 51.4 个月和 63.3 个月。有 2 个例外，患者报告的结局相似：背侧颊黏膜组的排尿后滴沥（28.1%比 8.3%，P<.0001）和吻合口组的勃起时牵拉感（23.4%比 3.1%，P=.008）更常见。吻合口组和背侧颊黏膜组分别有 98%和 91%的患者会再次选择他们的手术（P=.07）。
吻合口尿道成形术和背侧颊黏膜游离移植尿道成形术均具有较高的成功率，且满意度相当。尽管存在固有狭窄长度差异，但无论采用何种方法，患者报告的结局测量指标均相似。我们的数据表明，不应因担心性副作用而避免行吻合口尿道成形术。
