Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Urology, School of Medicine, University of St, Gallen, St. Gallen, Switzerland.
World J Urol. 2021 Sep;39(9):3533-3539. doi: 10.1007/s00345-021-03648-y. Epub 2021 Mar 11.
To evaluate the interplay of stricture recurrence, sexual function, and treatment satisfaction after substitution urethroplasty.
Observational study of men undergoing 1-stage buccal mucosal graft urethroplasty for anterior urethral stricture between 2009 and 2016. Patients were dichotomized by self-reported treatment satisfaction. Sexual function was assessed by validated and non-validated patient-reported outcome measures. Functional recurrence was defined as symptomatic need of re-intervention. Bivariate analyses, Kaplan-Meier estimates, qualitative and quantitative analyses by uni- and multivariable regression were employed to evaluate the interplay of sexual function, functional recurrence, and treatment satisfaction.
Of 534 men with bulbar (82%), penobulbar (11%), and penile strictures (7.3%), 451 (84%) were satisfied with the surgery. There were no differences in stricture location, previous treatment, graft length, or surgical technique between satisfied and unsatisfied patients (all p ≥ 0.2). Recurrence-free survival was 85% at a median follow-up of 33 mo and decreased significantly with each Likert item towards increasing dissatisfaction (p < 0.001). Dissatisfied patients more often reported postoperative loss of rigidity, tumescence, reduced ejaculatory volume, ejaculatory pain, and reduced penile length (all p ≤ 0.042). In 83 dissatisfied men, functional recurrence (28%) and oral morbidity (20%) were the main drivers of dissatisfaction in qualitative analysis. Multivariable analyses revealed functional recurrence and impaired postoperative ejaculatory function as independent predictors of treatment dissatisfaction (all p ≤ 0.029) after adjusting for confounders.
We found an association of both functional success and sexual function with patient-reported treatment satisfaction after substitution urethroplasty. Such findings validate the clinical significance of defining the symptomatic need for re-intervention as an endpoint and underline the importance of further research evaluating sexual function before and after open urethral reconstruction.
评估一期颊黏膜移植尿道成形术后尿道狭窄复发、性功能与治疗满意度之间的相互作用。
本研究为 2009 年至 2016 年间行一期颊黏膜移植尿道成形术治疗前尿道狭窄的男性患者的观察性研究。根据患者自我报告的治疗满意度将其分为两组。采用经过验证和未经验证的患者报告结局评估性功能。将功能复发定义为有症状需要再次干预的需要。采用双变量分析、Kaplan-Meier 估计、单变量和多变量回归的定性和定量分析来评估性功能、功能复发和治疗满意度之间的相互作用。
534 例球部（82%）、前-球部（11%）和阴茎部（7.3%）狭窄患者中，451 例（84%）对手术满意。满意组和不满意组在狭窄位置、既往治疗、移植物长度或手术技术方面无差异（均 p ≥ 0.2）。中位随访 33 个月时无复发生存率为 85%，且随着每个 Likert 项目向增加不满意的方向变化而显著降低（p < 0.001）。不满意的患者术后更常报告勃起硬度下降、阴茎肿胀、射精量减少、射精痛和阴茎长度缩短（均 p ≤ 0.042）。在 83 例不满意的患者中，功能复发（28%）和口腔并发症（20%）是定性分析中不满意的主要原因。多变量分析显示，在调整混杂因素后，功能复发和术后射精功能受损是治疗不满意的独立预测因素（均 p ≤ 0.029）。
我们发现一期颊黏膜移植尿道成形术后尿道狭窄复发和性功能与患者报告的治疗满意度之间存在关联。这些发现验证了将再次干预的症状需求定义为终点的临床意义，并强调了在开放尿道重建术前和术后评估性功能的重要性。
