Yadav Priyank, Danish Nayab, Sureka Sanjoy S, Rustagi Sanchit, Kapoor Rakesh, Srivastava Aneesh, Singh Uday Pratap
Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Turk J Urol. 2021 Mar;47(2):158-163. doi: 10.5152/tud.2020.20322. Epub 2020 Oct 9.
In complex strictures, especially in elderly patients, perineal urethrostomy (PU) provide excellent voiding function. This study aimed at evaluating the long-term voiding and erectile function of PU as a permanent procedure for such strictures.
We retrospectively evaluated 146 patients who underwent permanent PU at our institution from January 2000 to December 2018. All patients had complex urethral strictures. Patients with posterior urethral involvement were excluded. Patients were followed up at 3 months and then yearly. Failure was defined as the need for any additional procedures. They were also evaluated with the International Index of Erectile Function (IIEF-5) questionnaire. Fisher's exact test and χ test were used for statistical analysis.
The median age at the time of surgery was 58±7.3 years. The mean stricture length was 6.5±2.1 cm. All the patients had a history of previous surgery, and the average number of procedures per patient was 2.4. The median follow-up period was 26 months. The most common early and late postoperative complications were bleeding and stenosis of the urethrostomy, respectively. A total of 129 (88.3%) patients had a successful surgery. The number of patients with no erectile dysfunction increased from 55.4% to 67.8% after PU. The mean IIEF-5 score improved from 20.07 to 21.31 after PU, but this did not achieve statistical significance (p=0.3558).
Permanent PU is an acceptable option for complex long-segment anterior urethral strictures, especially in elderly patients, with an excellent long-term outcome. A majority of patients also maintain a satisfactory erectile function.
在复杂性尿道狭窄患者中，尤其是老年患者，会阴尿道造口术（PU）可提供良好的排尿功能。本研究旨在评估将PU作为此类狭窄的永久性手术的长期排尿和勃起功能。
我们回顾性评估了2000年1月至2018年12月在我院接受永久性PU手术的146例患者。所有患者均患有复杂性尿道狭窄。排除后尿道受累患者。患者在术后3个月进行随访，之后每年随访一次。手术失败定义为需要进行任何额外手术。还使用国际勃起功能指数（IIEF-5）问卷对患者进行评估。采用Fisher精确检验和χ检验进行统计学分析。
手术时的中位年龄为58±7.3岁。平均狭窄长度为6.5±2.1厘米。所有患者均有既往手术史，每位患者的平均手术次数为2.4次。中位随访期为26个月。最常见的早期和晚期术后并发症分别是出血和尿道造口狭窄。共有129例（88.3%）患者手术成功。PU术后无勃起功能障碍的患者数量从55.4%增加到67.8%。PU术后IIEF-5平均评分从20.07提高到21.31，但差异无统计学意义（p=0.3558）。
永久性PU是治疗复杂性长段前尿道狭窄的可接受选择，尤其是老年患者，长期效果良好。大多数患者也能维持满意的勃起功能。
