Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Urology. 2020 Dec;146:253-259. doi: 10.1016/j.urology.2020.07.073. Epub 2020 Sep 18.
To evaluate the impact of cardiovascular, metabolic and smoking related risk factors on recurrence in patients with buccal mucosal graft urethroplasty for anterior urethral strictures.
Retrospective single-center analysis between 2009 and 2016. Covariates included American Society of Anesthesiology (ASA) score, body mass index, and smoking status (never vs ever), coronary artery disease, arterial hypertension, diabetes mellitus, change in hemoglobin, creatinine, c-reactive protein, and leucocyte count. Descriptive and survival analyses evaluated the association with stricture recurrence.
Overall, 1039 patients had buccal mucosal graft urethroplasty of which 517 remained for final analysis. Patients with stricture recurrence (n = 76) were significantly older (P < .001), had a higher American Society of Anesthesiology score (P = .006), higher proportion coronary artery disease (P = .011), and hypertension (P = .003) compared to those patients without stricture recurrence. Patients without stricture recurrence had a significantly larger drop in hemoglobin (1.5 [0.9, 2.1] vs 1.2 [0.7, 1.8]) mg/dl ( = .005).Overall stricture-free recurrence rate was 86%, with a median follow-up of 32 (95% confidence interval: 26-30) months. In multivariable analysis, a larger drop of hemoglobin remained the only independent, statistically significant negative predictor of stricture recurrence (Hazard ratio, 95% confidence interval: 0.74, 0.57-0.97, P = .03).
A larger drop of hemoglobin is independently associated with recurrence free survival. This may be considered as a surrogate marker for good microvascular circulation of the corpus spongiosum and therefore neovascularization of the graft. Contrary to the existing and mostly heterogenous previous studies, our findings suggest that stricture recurrence is largely independent of cardiovascular and metabolic risk factors.
评估心血管、代谢和吸烟相关危险因素对前尿道狭窄行颊黏膜移植尿道成形术患者复发的影响。
这是一项 2009 年至 2016 年期间进行的回顾性单中心分析。协变量包括美国麻醉医师协会（ASA）评分、体重指数和吸烟状况（从不吸烟 vs 曾吸烟）、冠状动脉疾病、动脉高血压、糖尿病、血红蛋白、肌酐、C 反应蛋白和白细胞计数的变化。描述性和生存分析评估了与狭窄复发的相关性。
共有 1039 例患者行颊黏膜移植尿道成形术，其中 517 例患者最终纳入分析。复发组（n=76）患者明显年龄更大（P<0.001）、ASA 评分更高（P=0.006）、冠状动脉疾病（P=0.011）和高血压（P=0.003）的比例更高。与无狭窄复发的患者相比，无狭窄复发的患者血红蛋白下降幅度明显更大（1.5[0.9，2.1] vs 1.2[0.7，1.8]）（P=0.005）。总的无狭窄复发率为 86%，中位随访时间为 32（95%置信区间：26-30）个月。多变量分析显示，血红蛋白下降幅度较大仍是狭窄复发的唯一独立、统计学显著的负预测因素（风险比，95%置信区间：0.74，0.57-0.97，P=0.03）。
血红蛋白下降幅度较大与无复发生存独立相关。这可被视为海绵体微血管循环良好和移植物新生血管化的替代标志物。与现有的、大多数异质的既往研究相反，我们的研究结果表明，狭窄复发在很大程度上与心血管和代谢危险因素无关。
