Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Urology. 2020 Sep;143:248-254. doi: 10.1016/j.urology.2020.05.070. Epub 2020 Jun 17.
To report long-term surgical outcomes after urethroplasty for failed hypospadias repair (FHR) related strictures in adults.
A database of all adult (≥18 years) men who underwent urethroplasty since 2000 at Ghent University Hospital was created (prospective data since 2008). Patients with a follow-up <1 year or non-FHR related strictures were excluded. Postoperative complications were categorized according to Clavien-Dindo (<90 days), high-grade being ≥ grade 3. Failure was defined as stricture recurrence at the site of reconstruction requiring additional urethral manipulation. For penile strictures, outcomes were stratified per surgical technique.
In total, 85 patients were included with a median (IQR) follow-up of 89 (57-165) months. Respectively 76, 6 and 3 patients had a penile, bulbar and penobulbar stricture. Postoperative complication rate was 27%. High-grade complications were seen in 7 of 85 (8.2%) patients and in 4 of 85 (4.7%) patients this involved fistula formation. Failure occurred in 29 of 85 (34%) patients, corresponding with a failure-free survival estimate (SD) of 82% (4.1), 73% (5.0) and 57% (6.7) after respectively 1, 5 and 10 years. For penile strictures, anastomotic repair had the highest failure rate (5/7, 71%) and a first stage Johanson procedure only had the lowest failure rate (1/10, 10%), followed by definitive perineal urethrostomy (1/4, 25%), pedicled flap urethroplasty (2/8, 25%) and free graft urethroplasty (7/23, 30%).
FHR related strictures are predominantly seen in the penile urethra. Failure rate after urethroplasty for FHR related strictures increases steadily over time suggesting prolonged follow-up in these patients. For penile FHR related strictures, anastomotic repair should be discouraged.
报告成人因失败的尿道下裂修复（FHR）相关狭窄而进行尿道成形术的长期手术结果。
创建了一个自 2000 年以来在根特大学医院接受尿道成形术的所有成年（≥18 岁）男性的数据库（自 2008 年以来为前瞻性数据）。排除随访时间<1 年或非 FHR 相关狭窄的患者。根据 Clavien-Dindo（<90 天）对术后并发症进行分类，高级别为≥3 级。失败定义为在重建部位复发的狭窄，需要额外的尿道操作。对于阴茎狭窄，根据手术技术对结果进行分层。
共纳入 85 例患者，中位（IQR）随访时间为 89（57-165）个月。分别有 76、6 和 3 例患者有阴茎、球部和阴茎球部狭窄。术后并发症发生率为 27%。85 例患者中有 7 例（8.2%）出现高级别并发症，其中 4 例（4.7%）发生瘘管形成。85 例患者中有 29 例（34%）发生失败，对应于无失败生存估计（SD）分别为 82%（4.1）、73%（5.0）和 57%（6.7）在 1、5 和 10 年后。对于阴茎狭窄，吻合修复的失败率最高（7/7，71%），而第一阶段 Johanson 手术的失败率最低（1/10，10%），其次是确定性会阴尿道成形术（1/4，25%）、带蒂皮瓣尿道成形术（2/8，25%）和游离移植物尿道成形术（7/23，30%）。
FHR 相关狭窄主要见于阴茎尿道。FHR 相关狭窄尿道成形术后的失败率随着时间的推移稳步增加，表明这些患者需要延长随访时间。对于阴茎 FHR 相关狭窄，应避免吻合修复。
