Department of Urology, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
World J Urol. 2020 Dec;38(12):3251-3259. doi: 10.1007/s00345-020-03123-0. Epub 2020 Feb 19.
To identify independent risk factors for urethroplasty failure in a prospective dataset.
Since 2008, data of all male patients undergoing urethroplasty at Ghent University Hospital have been prospectively recorded and maintained. This analysis excluded: posterior strictures, strictures of the perineostomy, urethral malignancy-related strictures, age < 18 years and follow-up < 1 year. Postoperatively, a voiding cysto-urethrography (VCUG) was performed after 2 weeks and in absence of significant contrast extravasation, the transurethral catheter was removed. Patients were followed after 3 m, 12 m and annually thereafter. Failure was defined as stricture recurrence requiring additional urethral intervention(s). Uni- and multivariate Cox regression analyses were performed on the entire patient cohort and for one-stage urethroplasty (OSU) at specific locations.
In total, 474 patients were included. Median follow-up was 62 m (IQR 35-91). Significant extravasation was present in 6.9%. Bulbar stricture location was identified as independent protective factor for urethroplasty failure (HR 0.44; p = 0.046) and significant extravasation at first VCUG was identified as independent risk factor for urethroplasty failure (HR 2.86; p = 0.005). Cox regression analyses for OSU at specific locations could not identify other risk factors. All but one (89%) of the failures preceded by significant extravasation at first VCUG occurred within 2 years of follow-up whereas 44% of the failures with no or insignificant extravasation at first VCUG occurred after 2 years of follow-up (p = 0.03).
Bulbar stricture location is an independent protective factor for urethroplasty failure. Significant extravasation at first urethrography is an independent risk factor for urethroplasty failure and is associated with earlier stricture recurrence than other failed cases.
在一个前瞻性数据集中确定尿道成形术失败的独立危险因素。
自 2008 年以来，根特大学医院所有接受尿道成形术的男性患者的数据均被前瞻性地记录和保存。本分析排除了：后尿道狭窄、会阴部吻合口狭窄、尿道恶性肿瘤相关狭窄、年龄＜18 岁和随访＜1 年。术后 2 周进行排尿性膀胱尿道造影（VCUG），如果没有明显的造影剂外渗，就会移除经尿道导管。患者在 3 个月、12 个月和此后每年进行随访。失败定义为需要额外尿道介入治疗的狭窄复发。对整个患者队列和特定部位的一期尿道成形术（OSU）进行单变量和多变量 Cox 回归分析。
共纳入 474 例患者。中位随访时间为 62 个月（IQR 35-91）。6.9%的患者存在明显外渗。球部狭窄部位是尿道成形术失败的独立保护因素（HR 0.44；p=0.046），首次 VCUG 存在明显外渗是尿道成形术失败的独立危险因素（HR 2.86；p=0.005）。特定部位 OSU 的 Cox 回归分析无法确定其他危险因素。所有（89%）在首次 VCUG 存在明显外渗的失败病例均发生在随访的 2 年内，而在首次 VCUG 无或轻微外渗的失败病例中，有 44%发生在随访 2 年后（p=0.03）。
球部狭窄部位是尿道成形术失败的独立保护因素。首次尿道造影明显外渗是尿道成形术失败的独立危险因素，与其他失败病例相比，狭窄复发更早。
