Rumeli University, İstanbul, Turkey.
Private Safa Hospital, İstanbul, Turkey.
Urologia. 2023 May;90(2):315-321. doi: 10.1177/03915603221148532. Epub 2023 Jan 13.
We wished to compare the treatment success of urethroplasty methods (EPA and BMG) used for anterior urethra stricture after unsuccessful internal urethrotomy.
A total of 85 and 51 patients, respectively, who underwent excision and primary anastomosis (EPA) and buccal mucosal graft (BMG) urethroplasty due to recurrent strictures after direct vision internal urethrotomy (DVIU) were evaluated retrospectively. On the uroflowmetry test, >15 ml/s urine flow and residual urine (PVR) below 50 ml were determined as success criteria. Cox regression analysis investigated the probable predictive factors for surgery success. Kaplan-Meier analysis assessed stricture free survival after redo-urethroplasty.
After surgery, EPA and BMG patients were followed for 31.9 ± 9.8 (4-40) and 30.7 ± 10.3 (4-40) months. At the end of this follow-up duration, success was obtained for 71 (83.5%) and 44 (86.3%) patients. Mean re-stricture times were 13.9 ± 6.0 (4-19) and 10.2 ± 5.1 (4-26) months. Most re-strictures had penile location (10 (71.5%) and 7 (100%)). After one session of DVIU, there was 100% success in both groups, but after >3 sessions of DVIU, success fell to 70.3% and 78.3% in the groups respectively. Patients with high numbers of DVIU sessions had longer durations for urethroplasty surgery. Apart from complications related to the donor field in the oral region with BMG and four patients who developed fistula (7.8%), complications were similar in both groups.
In this series of cases, it was not possible to identify which of the techniques employed provides the best result or predictive factors for stenosis recurrence after correction procedures for anterior urethral stenosis.
我们旨在比较经尿道内切开术（DVIU）后失败的前尿道狭窄患者中使用尿道成形术（EPA 和 BMG）的治疗成功率。
回顾性分析 85 例和 51 例因 DVIU 后复发狭窄而行切除吻合术（EPA）和颊黏膜移植术（BMG）尿道成形术的患者。尿流率测试中，>15ml/s 的尿流和<50ml 的残余尿（PVR）被认为是成功标准。Cox 回归分析探讨了手术成功的可能预测因素。Kaplan-Meier 分析评估了再次尿道成形术后的无狭窄生存情况。
手术后，EPA 和 BMG 组患者的随访时间分别为 31.9±9.8（4-40）和 30.7±10.3（4-40）个月。在随访结束时，71 例（83.5%）和 44 例（86.3%）患者获得成功。再次狭窄的平均时间分别为 13.9±6.0（4-19）和 10.2±5.1（4-26）个月。大多数再次狭窄位于阴茎部位（10 例[71.5%]和 7 例[100%]）。DVIU 单次治疗后，两组成功率均为 100%，但 DVIU 次数>3 次后，两组成功率分别降至 70.3%和 78.3%。DVIU 次数较多的患者尿道成形术手术时间较长。除了 BMG 相关的口腔区域供区并发症和 4 例发生瘘管（7.8%）外，两组并发症相似。
在本系列病例中，无法确定哪种技术在矫正前尿道狭窄后狭窄复发的矫正术中效果更好或预测因素。
