Hoare Dylan T, Doiron R Christopher, Rourke Keith F
Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Department of Urology, Queen's University, Kingston, ON, Canada.
Can Urol Assoc J. 2022 Aug;16(8):289-293. doi: 10.5489/cuaj.7795.
The management of urethral stricture has evolved over the last several decades. We sought to analyze urethral stricture and urethroplasty trends at a tertiary referral center over a 15-year period.
Patients undergoing urethroplasty by a single surgeon from August 2003 to July 2018 were analyzed. Patient demographics, urethroplasty techniques, and outcomes were collected in a prospectively maintained database and were categorized into three five-year tertiles based on date of surgery. These tertiles were subsequently retrospectively analyzed for trends and changes in practice.
A total of 1319 urethroplasties were completed over the study period. During the first five years (T1), 299 urethroplasties were performed, with 431 and 589 performed in T2 and T3, respectively. Mean overall patient age was 46.8 years, which increased significantly over time (p<0.001). Idiopathic strictures were most common (n=516, 39.1%) and unchanged over time, while proportionately radiation-induced strictures increased (n=9, 3.0% [T1], n=22, 5.1% [T2], n=51, 8.7% [T3]; p=0.001) as did iatrogenic and lichen sclerosus strictures. Mean stricture length (4.7 cm [T1], 4.8 cm [T2], 4.0 cm [T3]; p<0.001) and the mean number of prior endoscopic procedures (3.4 [T1], 3.9 [T2], and 2.5 [T3]; p<0.001] decreased over time. Single-stage urethroplasty with buccal mucosa was the most common technique performed (n=656, 49.7%) that increased in prevalence (p=0.009), while both flap and staged techniques decreased (p=0.008, p=0.004, respectively). Overall success rate was 90.1% (n=1106), which improved significantly with time (n=248, 86.7% [T1], n=359, 90.0% [T2], n=499, 93.4% [T3]; p=0.001).
We observed that patients and treatment of urethral stricture evolved over 15 years in practice, with an increase in patient age, radiation, and iatrogenic and lichen sclerosus strictures, while demonstrating a decrease in stricture length and the number of prior endoscopic procedures performed. Increased use of single-stage urethroplasty using buccal mucosa was observed, which may have contributed to an increase in urethroplasty success over time.
在过去几十年中，尿道狭窄的治疗方法不断发展。我们试图分析一家三级转诊中心在15年期间尿道狭窄和尿道成形术的趋势。
对2003年8月至2018年7月由单一外科医生进行尿道成形术的患者进行分析。患者的人口统计学资料、尿道成形术技术和结果被收集到一个前瞻性维护的数据库中，并根据手术日期分为三个五年期。随后对这些时期进行回顾性分析，以了解实践中的趋势和变化。
在研究期间共完成了1319例尿道成形术。在第一个五年期（T1），进行了299例尿道成形术，T2和T3分别进行了431例和589例。患者的平均总体年龄为46.8岁，随时间显著增加（p<0.001）。特发性狭窄最为常见（n=516，39.1%），且随时间无变化，而放射性狭窄的比例增加（n=9，3.0% [T1]，n=22，5.1% [T2]，n=51，8.7% [T3]；p=0.001），医源性和硬化性苔藓性狭窄也增加。平均狭窄长度（4.7 cm [T1]，4.8 cm [T2]，4.0 cm [T3]；p<0.001）和先前内镜手术的平均次数（3.4 [T1]，3.9 [T2]，2.5 [T3]；p<0.001）随时间减少。使用颊黏膜的一期尿道成形术是最常用的技术（n=656，49.7%），其患病率增加（p=0.009），而皮瓣和分期技术均减少（分别为p=0.008，p=0.004）。总体成功率为90.1%（n=1106），随时间显著提高（n=248，86.7% [T1]，n=359，90.0% [T2]，n=499，93.4% [T3]；p=0.001）。
我们观察到，在实践中，尿道狭窄患者及其治疗在15年中发生了变化，患者年龄、放射性、医源性和硬化性苔藓性狭窄增加，而狭窄长度和先前进行的内镜手术次数减少。观察到使用颊黏膜的一期尿道成形术的使用增加，这可能是随着时间推移尿道成形术成功率提高的原因。
