Tabei Tadashi, Horiguchi Akio, Ojima Kenichiro, Shinchi Masayuki, Kobayashi Kazuki, Ito Keiichi, Azuma Ryuichi
Department of Urology, Yokosuka Kyosai Hospital, Kanagawa, Japan.
Department of Urology, National Defense Medical College, Saitama, Japan.
Int J Urol. 2021 Jul;28(7):742-747. doi: 10.1111/iju.14547. Epub 2021 Mar 19.
To investigate the efficacy of re-do urethroplasty for post-traumatic urethral stricture in terms of anatomical and functional outcomes.
A total of 48 patients who underwent re-do urethroplasty for post-traumatic urethral stricture due to perineal trauma (n = 21) and pelvic fracture urethral injury (n = 27) between October 2010 and March 2020 were retrospectively reviewed. Patients were followed by uroflowmetry, post-void residual volume assessment and 17-Fr flexible cystoscopy after re-do urethroplasty. Successful urethroplasty was defined as having a urethral caliber adequate for the passage of a cystoscope and requiring no additional treatments. Patients completed a validated patient-reported outcome measure for urethral stricture surgery, including overall satisfaction, and the sexual health inventory for men.
The type of re-do urethroplasty was anastomotic urethroplasty in 45 (94%) patients and buccal mucosa urethroplasty in three (6%) patients. Urethroplasty was successful in 47 (98%) patients (median follow up 35 months, interquartile range 21-75). The patient-reported outcome measure for urethral stricture surgery and Sexual Health Inventory for Men were assessed in 36 (75%) patients, and the mean lower urinary tract symptom-specific quality of life, EuroQol-5D and EuroQol-visual analog scale scores improved from 2.86, 0.63 and 54.17 preoperatively to 0.78 (P < 0.001), 0.86 (P < 0.001) and 76.94 (P < 0.001) postoperatively, respectively. The pre- and postoperative mean Sexual Health Inventory for Men scores (5.92 and 4.94, respectively) did not significantly differ (P = 0.318). All 36 patients were satisfied with their urethroplasty outcomes, with 20 (56%) very satisfied patients.
Re-do urethroplasty for post-traumatic urethral stricture shows a high success rate and beneficial effects on both anatomical and functional outcomes.
从解剖学和功能学结果方面探讨再次尿道成形术治疗创伤后尿道狭窄的疗效。
回顾性分析2010年10月至2020年3月期间因会阴创伤（n = 21）和骨盆骨折尿道损伤（n = 27）而接受再次尿道成形术治疗创伤后尿道狭窄的48例患者。再次尿道成形术后，通过尿流率测定、排尿后残余尿量评估和17F可弯曲膀胱镜检查对患者进行随访。成功的尿道成形术定义为尿道管径足以通过膀胱镜且无需额外治疗。患者完成了一份经过验证的尿道狭窄手术患者报告结局量表，包括总体满意度，以及男性性健康量表。
45例（94%）患者采用吻合性尿道成形术，3例（6%）患者采用颊黏膜尿道成形术。47例（98%）患者尿道成形术成功（中位随访35个月，四分位间距21 - 75）。对36例（75%）患者进行了尿道狭窄手术患者报告结局量表和男性性健康量表评估，术前下尿路症状特异性生活质量、欧洲五维健康量表和欧洲五维视觉模拟量表评分的平均值分别为2.86、0.63和54.17，术后分别改善至0.78（P < 0.001）、0.86（P < 0.001）和76.94（P < 0.001）。术前和术后男性性健康量表评分的平均值分别为5.92和4.94，差异无统计学意义（P = 0.318）。所有36例患者对尿道成形术的结果满意，其中20例（56%）患者非常满意。
再次尿道成形术治疗创伤后尿道狭窄成功率高，对解剖学和功能学结果均有有益影响。
