Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA.
Einstein Medical Center/Fox Chase Cancer Center, Philadelphia, PA, USA.
World J Urol. 2021 Jul;39(7):2669-2675. doi: 10.1007/s00345-020-03446-y. Epub 2020 Sep 17.
To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis.
Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010-2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction.
Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72 years, (IQR 66-75), and 3.0 cm (IQR 2.5-4 cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21 months (IQR 13-40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26 cc, p = 0.001) and Uroflow (4.6 to 15.9 cc/s, p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better).
Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.
对 10 家机构 2010 年至 2019 年间接受背侧-黏膜下颊黏膜移植尿道成形术（D-BMGU）治疗的复发性放射性后尿道狭窄患者进行回顾性多中心研究。
对 10 家机构的 79 例后尿道狭窄患者进行了回顾性多中心研究，这些患者至少有 1 年的随访。分析患者的人口统计学资料、狭窄特征、围手术期结果以及术后临床和患者报告的结果。主要结果是狭窄复发和新发压力性尿失禁（SUI）。次要结果是排尿、性功能和患者报告满意度的变化。
79 例接受 D-BMGU 治疗的放射性后尿道狭窄患者符合纳入标准。中位年龄和狭窄长度分别为 72 岁（IQR 66-75）和 3.0cm（IQR 2.5-4cm）。放射治疗方式包括：36 例（45.6%）外照射放疗（EBRT）、13 例（16.5%）近距离放疗（BT）、10 例（12.7%）EBRT/BT 联合治疗和 20 例（25.3%）EBRT/根治性前列腺切除术。在中位随访 21 个月（IQR 13-40）时，14 例患者（17.7%）出现狭窄复发。在 37 例术前控尿的患者中，3 例（8.1%）在背侧尿道成形术后新发压力性尿失禁。29 例术前有尿失禁的患者中，除 1 例外，其余患者术后均持续失禁（96.6%）。术后患者的膀胱残余尿量（PVR）（从 92.5 降至 26cc，p=0.001）和尿流率（从 4.6 升至 15.9cc/s，p=0.001）均显著改善，总体满意度高，91.9%的患者报告 GRA 评分+2 或更好）。
背侧-黏膜下颊黏膜移植尿道成形术是治疗放射性后尿道狭窄患者的一种安全可行的技术。这种非切开的方法可能会降低新发压力性尿失禁的发生率。需要进一步的研究来比较这种技术与切除性尿道成形术。
