Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Urology. 2020 Apr;138:160-165. doi: 10.1016/j.urology.2019.11.064. Epub 2020 Jan 28.
To explore indications for a definitive perineal urethrostomy (PU). To objectify the proportion of patients not completing the final stage procedure in an intended multi-stage urethroplasty. To analyze the incentives for both of these scenarios.
Since 2000, data of all men undergoing urethroplasty at our center have been collected in a database. This study included patients with a definitive PU and patients after ≥1 stages of an intended multi-stage urethroplasty. Patients <18 years or with a follow-up <3 m were excluded. Descriptive statistics were used and groups were compared with nonparametric statistical tests.
Among 1015 urethroplasties, 34 patients underwent a definitive PU and 63 underwent ≥1 stages of an intended multi-stage urethroplasty with a median (IQR) follow-up of respectively 57 (31-120) and 32 (14-101) months. In the definitive PU group, patients were significantly older (P < .001) and had more cardiovascular comorbidity (P = .01), panurethral stricture disease (P = .02) and longer strictures (P = .02) than patients in the multi-stage urethroplasty group. Half of the definitive PUs were surgeon driven and 33% were patient driven. Final stage procedures were completed by 35/63 (56%) patients. Patients not completing the final stage were significantly older (P = .001).
Definitive PU is particularly performed in older patients with worse cardiovascular condition, panurethral stricture disease and longer strictures. PU is often explicitly chosen by well informed patients and as nearly half of the patients refuse closure of the urethrostomy after the first stage, a definitive PU should be proposed as reasonable alternative to complicated urethral reconstruction from the start, especially in older patients.
探讨确定性经会阴尿道吻合术（PU）的适应证。客观比较预期多阶段尿道成形术中未能完成最后阶段手术的患者比例。分析这两种情况的诱因。
自 2000 年以来，我们中心所有接受尿道成形术的男性患者的数据均已在数据库中收集。本研究包括接受确定性 PU 的患者和接受预期多阶段尿道成形术≥1 个阶段的患者。排除年龄<18 岁或随访<3 个月的患者。采用描述性统计方法，并用非参数统计检验比较组间差异。
在 1015 例尿道成形术中，34 例患者接受了确定性 PU，63 例患者接受了≥1 个阶段的预期多阶段尿道成形术，中位（IQR）随访时间分别为 57（31-120）和 32（14-101）个月。在确定性 PU 组中，患者年龄明显较大（P<0.001），心血管合并症更多（P=0.01），全尿道狭窄疾病更多（P=0.02），狭窄长度更长（P=0.02）。一半的确定性 PU 是由外科医生驱动的，33%是由患者驱动的。63 例患者中有 35 例（56%）完成了最后阶段的手术。未完成最后阶段手术的患者年龄明显较大（P=0.001）。
确定性 PU 主要用于年龄较大、心血管状况较差、全尿道狭窄疾病和狭窄较长的患者。PU 通常是由知情患者明确选择的，由于近一半的患者在第一阶段后拒绝关闭尿道造口，因此从一开始就应将确定性 PU 作为复杂尿道重建的合理替代方案提出，特别是在老年患者中。
