Hwang Eu Chang, de Fazio Adam, Hamilton Kallie, Bakker Caitlin, Pariser Joseph J, Dahm Philipp
Department of Urology, Chonnam National University Medical School, Hwasun, Korea.
Department of Urology, University of Minnesota, Minneapolis, MN, USA.
World J Mens Health. 2022 Jan;40(1):116-126. doi: 10.5534/wjmh.200175. Epub 2021 Feb 15.
To assess the effects of buccal mucosal graft site non-closure closure on postoperative oral morbidity for male undergoing augmentation urethroplasty for urethral stricture.
We included randomized controlled trials. Inclusion criteria were male over the age of 18 with urethral stricture disease requiring reconstruction with buccal mucosal graft harvest. Primary outcomes of the review were postoperative oral pain, need for secondary oral procedures and cosmetic defects.
We included 5 studies with 346 randomized patients with urethral strictures, of whom 260 completed the trials. In terms of primary outcomes, non-closure graft site may reduce oral pain on postoperative day #1 (standard mean difference [SMD] 0.24 lower; 95% confidence interval [CI] 0.61 lower to 0.12 higher; low certainty evidence [CoE]) but we are uncertain how this impacts pain on postoperative days 3 to 6 (SMD 0.35; 95% CI 0.12 to 0.81 higher; very low CoE). We are also very uncertain as to how it affects the need for secondary oral procedures (risk ratio [RR] 0.22; 95% CI 0.01 to 4.28; very low CoE). Non-closure may increase the risk of cosmetic defects (RR 2.40; 95% CI 0.93 to 6.22; low CoE).
This review describes the trade-off for buccal mucosal graft site non-closure closure for various patient-important outcomes; decision-making will likely hinge on the relative value individual patients and surgeons place on them. The supporting evidence was rated as low and very low, thereby signaling substantial underlying uncertainty and the need for better trials.
评估尿道狭窄行尿道成形术的男性患者，颊黏膜移植部位不闭合与闭合对术后口腔发病率的影响。
我们纳入了随机对照试验。纳入标准为年龄超过18岁、患有尿道狭窄疾病且需要通过采集颊黏膜进行重建的男性患者。本综述的主要结局为术后口腔疼痛、二次口腔手术需求及美容缺陷。
我们纳入了5项研究，共346例随机分组的尿道狭窄患者，其中260例完成了试验。在主要结局方面，移植部位不闭合可能会减轻术后第1天的口腔疼痛（标准化均数差[SMD]低0.24；95%置信区间[CI]低0.61至高0.12；低确定性证据[CoE]），但我们不确定这对术后第3至6天的疼痛有何影响（SMD 0.35；95%CI高0.12至高0.81；极低CoE）。我们也非常不确定其对二次口腔手术需求的影响（风险比[RR] 0.22；95%CI 0.01至4.28；极低CoE）。不闭合可能会增加美容缺陷的风险（RR 2.40；95%CI 0.93至6.22；低CoE）。
本综述描述了颊黏膜移植部位不闭合与闭合在各种对患者重要的结局方面的权衡；决策可能取决于个体患者和外科医生对这些结局的相对重视程度。支持证据的等级为低和极低，这表明存在很大的潜在不确定性，需要进行更好的试验。
