Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
J Urol. 2022 Aug;208(2):350-359. doi: 10.1097/JU.0000000000002688. Epub 2022 Apr 4.
The purpose of this study was to determine the incidence of 90-day complications after urethroplasty and identify factors associated with them.
A single-institution, 2-surgeon retrospective review was performed on patients undergoing urethroplasty from August 2003-June 2020. Variables included the incidence, type and Clavien-Dindo grade of complications, patient age, individual comorbidities, comorbidity component of the Charlson Comorbidity Index (CCI), smoking status, obesity (body mass index ≥35 kg/m), bacteriuria, type of urethroplasty, stricture etiology, length, location, prior endoscopic procedures, previous urethroplasty and preoperative suprapubic catheterization. The primary outcome was the incidence of significant 90-day complications defined as Clavien grade ≥2. Descriptive statistics were used to summarize the results and binary logistic regression was used to examine the factors associated with 90-day complications.
Of the 1,611 patients included in the analysis, 90-day complications (Clavien ≥2) occurred in 7.9% (128/1,611) and were wound related (3.5%), urinary tract infection (3.4%), cardiovascular (0.4%), catheter-related (0.2%), hematuria (0.1%) or retention (0.1%). On univariable binary logistic regression stricture location (p=0.04), stricture length (p=0.009), CCI (p <0.0001), prior urethroplasty (p=0.01) and bacteriuria (p=0.002) were associated with complications, while age (p=0.3), etiology (p=0.2), smoking (p=0.2), obesity (p=0.3), failed endoscopic treatment (p=0.8), indwelling suprapubic catheter (p=0.7) and type of urethroplasty (p=0.09) were not. On multivariable analysis, increasing CCI (Odds Ratio 1.31, 95% CI 1.10-1.56; p=0.003), prior urethroplasty (OR 1.86, 95% CI 1.09-3.17; p=0.02) and preoperative bacteriuria (OR 1.67, 95% CI 1.14-2.45; p=0.009) remained associated with 90-day complications.
Patients with increased comorbidities, prior urethroplasty and preoperative bacteriuria are at higher risk for complications after urethroplasty and should be counseled accordingly in a shared decision-making model of care.
本研究旨在确定尿道成形术后 90 天并发症的发生率，并确定与之相关的因素。
对 2003 年 8 月至 2020 年 6 月期间接受尿道成形术的患者进行了单机构、2 名外科医生的回顾性研究。变量包括并发症的发生率、类型和 Clavien-Dindo 分级、患者年龄、个体合并症、Charlson 合并症指数（CCI）的合并症成分、吸烟状况、肥胖（体重指数≥35kg/m）、菌尿、尿道成形术类型、狭窄病因、长度、位置、先前的内镜治疗、先前的尿道成形术和术前耻骨上导尿。主要结局为定义为 Clavien 分级≥2 的显著 90 天并发症的发生率。采用描述性统计来总结结果，采用二元逻辑回归来检查与 90 天并发症相关的因素。
在纳入分析的 1611 例患者中，90 天并发症（Clavien≥2）发生率为 7.9%（128/1611），与伤口相关（3.5%）、尿路感染（3.4%）、心血管（0.4%）、导管相关（0.2%）、血尿（0.1%）或留置（0.1%）有关。在单变量二元逻辑回归中，狭窄位置（p=0.04）、狭窄长度（p=0.009）、CCI（p<0.0001）、先前的尿道成形术（p=0.01）和菌尿（p=0.002）与并发症相关，而年龄（p=0.3）、病因（p=0.2）、吸烟（p=0.2）、肥胖（p=0.3）、内镜治疗失败（p=0.8）、耻骨上留置导尿管（p=0.7）和尿道成形术类型（p=0.09）无相关性。多变量分析显示，CCI 增加（优势比 1.31，95%置信区间 1.10-1.56；p=0.003）、先前的尿道成形术（OR 1.86，95%CI 1.09-3.17；p=0.02）和术前菌尿（OR 1.67，95%CI 1.14-2.45；p=0.009）与 90 天并发症仍相关。
患有合并症增加、先前有尿道成形术和术前菌尿的患者在尿道成形术后发生并发症的风险更高，应在共同决策的护理模式中对其进行相应的咨询。
