Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
Division of Urology, University of Alberta, Edmonton, Alberta, Canada.
Urology. 2020 Jul;141:162-167. doi: 10.1016/j.urology.2020.02.034. Epub 2020 Apr 10.
To better define patient-reported outcomes after urethroplasty. While urethroplasty is the most effective treatment for urethral stricture, the majority of outcomes are reported using surgeon-defined endpoints.
Patients were enrolled in a prospective study evaluating patient-reported outcomes after urethroplasty from 2012 to 2018. A number of domains were assessed preoperatively and 6 months postoperatively using both validated and nonvalidated measures including satisfaction, voiding function, urinary quality of life, erectile/ejaculatory function, penile appearance/curvature, and genitourinary pain.
Of 357 patients completing the study, mean age was 49.7 years with mean stricture length of 4.4 cm. Total 95.9% of patients were stricture-free on 6-month cystoscopy. Eighty percent of patients reported being satisfied with surgery, while 7.3% of patients were unsatisfied. Voiding function was globally improved after urethroplasty including International Prostate Symptom Score (19.3 vs 6.0; P < .0001), urinary quality of life (4.7 vs 1.6; P < .0001), postvoid dribbling (2.7 vs 2.5; P = .04), and sitting to void (2.4 vs 1.9; P < .0001). Additionally, genitourinary pain improved postoperatively (2.2 vs 1.6; P < .0001). Mean erectile function remained unchanged (17.7 vs 17.2; P = .46) but 12.0% of patients reported new onset erectile dysfunction. Reported ejaculatory dysfunction did not change significantly postoperatively (P = .13) but 7.1% of patients reported new ejaculatory dysfunction. Total 6.7% and 3.1% of patients complained of bothersome loss of penile length or curvature, respectively.
Urethroplasty improves voiding function and genitourinary pain associated with urethral stricture. While sexual function is preserved for the majority of patients, a small proportion of patients describe new onset erectile dysfunction, penile shortening or curvature and should be counselled accordingly.
更好地定义尿道成形术后的患者报告结局。虽然尿道成形术是治疗尿道狭窄最有效的方法，但大多数结果都是使用外科医生定义的终点来报告的。
从 2012 年到 2018 年，患者参加了一项评估尿道成形术后患者报告结局的前瞻性研究。使用已验证和未验证的措施评估了术前和术后 6 个月的多个领域，包括满意度、排尿功能、尿生活质量、勃起/射精功能、阴茎外观/曲率和泌尿生殖系统疼痛。
357 名完成研究的患者中，平均年龄为 49.7 岁，平均狭窄长度为 4.4 厘米。6 个月膀胱镜检查时，95.9%的患者无狭窄。80%的患者对手术满意，而 7.3%的患者不满意。尿道成形术后排尿功能整体改善，包括国际前列腺症状评分（19.3 分比 6.0 分；P<0.0001）、尿生活质量（4.7 分比 1.6 分；P<0.0001）、排尿后滴沥（2.7 分比 2.5 分；P=0.04）和坐姿排尿（2.4 分比 1.9 分；P<0.0001）。此外，术后泌尿生殖系统疼痛改善（2.2 分比 1.6 分；P<0.0001）。平均勃起功能保持不变（17.7 分比 17.2 分；P=0.46），但 12.0%的患者报告新发生勃起功能障碍。术后射精功能无明显变化（P=0.13），但 7.1%的患者报告新发生射精功能障碍。分别有 6.7%和 3.1%的患者抱怨阴茎长度或曲率明显丧失。
尿道成形术可改善与尿道狭窄相关的排尿功能和泌尿生殖系统疼痛。尽管大多数患者的性功能得以保留，但仍有少数患者出现新的勃起功能障碍、阴茎缩短或弯曲，应相应告知。
