Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany.
World J Urol. 2020 Nov;38(11):2863-2872. doi: 10.1007/s00345-020-03102-5. Epub 2020 Feb 18.
To evaluate objective treatment success and subjective patient-reported outcomes in patients with radiation-induced urethral strictures undergoing single-stage urethroplasty.
Monocentric study of patients who underwent single-stage ventral onlay buccal mucosal graft urethroplasty for a radiation-induced stricture between January 2009 and December 2016. Patients were characterized by descriptive analyses. Kaplan-Meier estimates were employed to plot recurrence-free survival. Recurrence was defined as any subsequent urethral instrumentation (dilation, urethrotomy, urethroplasty). Patient-reported functional outcomes were evaluated using the validated German extension of the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS PROM).
Overall, 47 patients were available for final analyses. Median age was 70 (IQR 65-74). Except for two, all patients had undergone pelvic radiation therapy for prostate cancer. Predominant modality was external beam radiation therapy in 70% of patients. Stricture recurrence rate was 33% at a median follow-up of 44 months (IQR 28-68). In 37 patients with available USS PROM data, mean six-item LUTS score was 7.2 (SD 4.3). Mean ICIQ sum score was 9.8 (SD 5.4). Overall, 53% of patients reported daily leaking and of all, 26% patients underwent subsequent artificial urinary sphincter implantation. Mean IIEF-EF score was 4.4 (SD 7.1), indicating severe erectile dysfunction. In 38 patients with data regarding the generic health status and treatment satisfaction, mean EQ-5D index score and EQ VAS score was 0.91 (SD 0.15) and 65 (SD 21), respectively. Overall, 71% of patients were satisfied with the outcome.
The success rate and functional outcome after BMGU for radiation-induced strictures were reasonable. However, compared to existing long-term data on non-irradiated patients, the outcome is impaired and patients should be counseled accordingly.
评估接受单阶段尿道成形术的放射性尿道狭窄患者的客观治疗成功率和主观患者报告结局。
这是一项单中心研究，纳入了 2009 年 1 月至 2016 年 12 月期间接受单阶段腹侧黏膜下移植术治疗放射性狭窄的患者。患者特征采用描述性分析。采用 Kaplan-Meier 估计绘制无复发生存率图。复发定义为任何后续的尿道操作（扩张、尿道切开术、尿道成形术）。采用经德国验证的尿道狭窄手术患者报告结局测量表（USS PROM）的扩展版评估患者报告的功能结局。
共有 47 例患者可进行最终分析。中位年龄为 70 岁（IQR 65-74）。除 2 例外，所有患者均因前列腺癌接受盆腔放疗。70%的患者主要采用外照射放疗。中位随访 44 个月（IQR 28-68）时，狭窄复发率为 33%。在 37 例有 USS PROM 数据的患者中，平均 6 项 LUTS 评分 7.2（SD 4.3）。平均 ICIQ 总分 9.8（SD 5.4）。总体而言，53%的患者报告有日常漏尿，所有患者中有 26%接受了后续人工尿道括约肌植入。平均 IIEF-EF 评分为 4.4（SD 7.1），表明存在严重的勃起功能障碍。在 38 例有一般健康状况和治疗满意度数据的患者中，平均 EQ-5D 指数评分和 EQ VAS 评分分别为 0.91（SD 0.15）和 65（SD 21）。总体而言，71%的患者对结局满意。
BMGU 治疗放射性狭窄的成功率和功能结局是合理的。然而，与非放射性患者的现有长期数据相比，结果受损，应相应告知患者。
