Voelzke B B, Leddy L S, Myers J B, Breyer B N, Alsikafi N F, Broghammer J A, Elliott S P, Vanni A J, Erickson B A, Buckley J C, Zhao L C, Wright T, Rourke K F
Department of Urology, University of Washington School of Medicine, Seattle, WA.
Division of Urology, University of Utah, Salt Lake City, UT.
Urology. 2021 Jun;152:117-122. doi: 10.1016/j.urology.2020.11.077. Epub 2021 Feb 6.
To evaluate the outcomes of excision and primary anastomosis (EPA) for radiation-associated bulbomembranous stenoses using a multi-institutional analysis. The treatment of radiation-associated urethral stenosis is typically complex owing to the adverse impact of radiation on adjacent tissue.
An IRB-approved multi-institutional retrospective review was performed on patients who underwent EPA for bulbomembranous urethral stenosis following prostate radiotherapy. Preoperative patient demographics, operative technique, and postoperative outcomes were abstracted from 1/2007-6/2018. Success was defined as voiding per urethra without the need for endoscopic treatment and a minimum follow-up of 12 months.
One hundred and thirty-seven patients from 10 centers met study criteria with a mean age of 69.3 years (50-86), stenosis length of 2.3 cm (1-5) and an 86.9% (119/137) success rate at a mean follow-up 32.3 months (12-118). Univariate Cox regression analysis identified increasing patient age (P = .02), stricture length (P <.0001) and combined modality radiotherapy (P = .004) as factors associated with stricture recurrence while body mass index (P = .79), diabetes (P = .93), smoking (P = .62), failed endoscopic treatment (P = .08) and gracilis muscle use (P = .25) were not. On multivariate analysis, increasing patient age (H.R.1.09, 95%CI 1.01-1.16; P = .02) and stenosis length (H.R.2.62, 95%CI 1.49-4.60; P = .001) remained associated with recurrence. Subsequent artificial urinary sphincter was performed in 30 men (21.9%), of which 25 required a transcorporal cuff and 5 developed cuff erosion.
EPA for radiation-associated urethral stenosis effectively provides unobstructed instrumentation-free voiding. However, increasing stenosis length and age are independently associated with surgical failure. Patients should be counseled that further surgery for incontinence may be necessary.
采用多机构分析评估切除及一期吻合术（EPA）治疗放射性球膜部狭窄的疗效。由于放疗对邻近组织的不利影响，放射性尿道狭窄的治疗通常较为复杂。
对前列腺放疗后接受EPA治疗球膜部尿道狭窄的患者进行了一项经机构审查委员会批准的多机构回顾性研究。从2007年1月至2018年6月提取患者术前人口统计学资料、手术技术及术后结果。成功定义为经尿道排尿且无需内镜治疗，且至少随访12个月。
来自10个中心的137例患者符合研究标准，平均年龄69.3岁（50 - 86岁），狭窄长度2.3 cm（1 - 5 cm），平均随访32.3个月（12 - 118个月）时成功率为86.9%（119/137）。单因素Cox回归分析确定患者年龄增加（P = 0.02）、狭窄长度（P < 0.0001）及联合放化疗（P = 0.004）为与狭窄复发相关的因素，而体重指数（P = 0.79）、糖尿病（P = 0.93）、吸烟（P = 0.62）、内镜治疗失败（P = 0.08）及使用股薄肌（P = 0.25）则无关。多因素分析显示，患者年龄增加（风险比1.09，95%置信区间1.01 - 1.16；P = 0.02）及狭窄长度（风险比2.62，95%置信区间1.49 - 4.60；P = 0.001）仍与复发相关。30例男性（21.9%）随后接受了人工尿道括约肌植入术，其中25例需要经会阴放置袖套，5例出现袖套侵蚀。
EPA治疗放射性尿道狭窄能有效实现无梗阻、无需器械辅助的排尿。然而，狭窄长度增加及年龄增长与手术失败独立相关。应告知患者可能需要进一步手术治疗尿失禁。
