Verla Wesley, Hoebeke Piet, Spinoit Anne-Françoise, Waterloos Marjan, Monstrey Stan, Lumen Nicolaas
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium.
Plast Reconstr Surg Glob Open. 2020 Feb 6;8(2):e2641. doi: 10.1097/GOX.0000000000002641. eCollection 2020 Feb.
Since the recommendation to perform excision and primary anastomosis (EPA) for isolated, short, anastomotic strictures in transmen, there have been no further reports about its results. This study aims to provide an updated and extended report about the results of EPA for the aforementioned indication.
Since 2002, data of all transmen in whom an EPA urethroplasty has been performed at Ghent University Hospital were collected in a database. Exclusion criteria for this analysis were age <18 years old, nonanastomotic strictures, and stricture length >3.0 cm. Postoperative complications were analyzed with descriptive statistics. Failure-free survival (FFS) was analyzed with Kaplan-Meier statistics. Need for further urethral manipulation was used as definition for failure. Potential predictors for failure were entered in a univariate Cox regression analysis.
In total, 44 patients were included with a median (interquartile range) follow-up of 40 months (7-125 months). Complications after EPA urethroplasty were present in 12 (27%) of the patients and mainly involved low-grade complications (11/44, 25%). After 1, 2, and 5 years, the estimated FFS rate (SD) was 61% (7.8), 61% (7.8), and 47% (9.1). Stricture length (hazard ratio [HR], 2.11; = 0.03), prior urethroplasty (HR, 3.53; = 0.008), and extravasation at first voiding cystourethrography (HR, 3.00; = 0.047) were identified as predictors for failure.
EPA for an isolated, short, anastomotic stricture in transmen is associated with low complication rates, but high failure rates. After 5 years, the estimated FFS rate is 47%. Stricture length, prior urethroplasty, and extravasation at first voiding cystourethrography are predictors for failure.
自从建议对经男性变性者孤立的、短的吻合口狭窄进行切除及一期吻合术（EPA）以来，尚无关于其结果的进一步报道。本研究旨在提供一份关于上述适应证的EPA结果的更新且扩展的报告。
自2002年起，在根特大学医院接受EPA尿道成形术的所有经男性变性者的数据被收集到一个数据库中。本分析的排除标准为年龄<18岁、非吻合口狭窄以及狭窄长度>3.0 cm。术后并发症采用描述性统计进行分析。无失败生存（FFS）采用Kaplan-Meier统计进行分析。将需要进一步的尿道操作作为失败的定义。将潜在的失败预测因素纳入单因素Cox回归分析。
总共纳入44例患者，中位（四分位间距）随访时间为40个月（7 - 125个月）。12例（27%）患者出现EPA尿道成形术后并发症，主要为轻度并发症（11/44，25%）。1年、2年和5年后，估计的FFS率（标准差）分别为61%（7.8）、61%（7.8）和47%（9.1）。狭窄长度（风险比[HR]，2.11；P = 0.03）、既往尿道成形术（HR，3.53；P = 0.008）以及首次排尿膀胱尿道造影时的外渗（HR，3.00；P = 0.047）被确定为失败的预测因素。
经男性变性者孤立的、短的吻合口狭窄的EPA并发症发生率低，但失败率高。5年后，估计的FFS率为47%。狭窄长度、既往尿道成形术以及首次排尿膀胱尿道造影时的外渗是失败的预测因素。
