Harraz Ahmed M, Nabeeh Adel, Elbaz Ramy, Abdelhamid Abdalla, Tharwat Mohamed, Elbakry Amr A, El-Hefnawy Ahmed S, El-Assmy Ahmed, Mosbah Ahmed, Zahran Mohamed H
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Arab J Urol. 2022 Nov 1;21(2):94-101. doi: 10.1080/2090598X.2022.2138119. eCollection 2023.
To identify cystourethrogram (CUG) findings that independently predict the outcome of posterior urethroplasty (PU) following pelvic fracture urethral injury (PFUI).
Findings of CUG included the location of the proximal end of the bulbar urethra in zones A (superficial) or B (deep) according to its relationship with the pubic arch. Others included the presence of pelvic arch fracture, bladder neck, and posterior urethral appearance. The primary outcome was the need for reintervention either endoscopically or by redo urethroplasty. Independent predictors were modeled using a logistic regression model and a nomogram was constructed and internally validated using 100-bootstrap resampling. Time-to-event analysis was performed to validate the results.
A total of 196 procedures in 158 patients were analyzed. The success rate was 83.7% with 32 (16.3%) procedures requiring direct vision internal urethrotomy, urethroplasty, or both in 13 (6.6%), 12 (6.1%), and 7 (3.6%) patients, respectively. On multivariate analysis, bulbar urethral end located at zone B (odds ratio [OR]: 3.1; 95% confidence interval [CI]: 1.1-8.5; p = 0.02), pubic arch fracture (OR: 3.9; 95%CI: 1.5-9.7; p = 0.003), and previous urethroplasty (OR: 4.2; 95% CI: 1.8-10.1; p = 0.001) were independent predictors. The same predictors were significant in the time-to-event analysis. The nomogram discrimination was 77.3% and 75% in the current data and after validation.
The location of the proximal end of the bulbar urethra and redo urethroplasty could predict the need for reintervention after PU for PFUI. The nomogram could be used preoperatively for patient counseling and procedure planning.
确定在骨盆骨折尿道损伤（PFUI）后能独立预测后尿道成形术（PU）结果的膀胱尿道造影（CUG）表现。
CUG的表现包括球部尿道近端根据其与耻骨弓的关系位于A区（表浅）或B区（深部）。其他表现包括耻骨弓骨折、膀胱颈及后尿道外观。主要结局是是否需要进行内镜下再次干预或再次行尿道成形术。使用逻辑回归模型建立独立预测因素模型，并构建列线图，通过100次自抽样重采样进行内部验证。进行事件发生时间分析以验证结果。
对158例患者的196例手术进行了分析。成功率为83.7%，32例（16.3%）手术需要直视下内尿道切开术、尿道成形术或两者均需，分别有13例（6.6%）、12例（6.1%）和7例（3.6%）患者。多因素分析显示，球部尿道末端位于B区（比值比[OR]：3.1；95%置信区间[CI]：1.1 - 8.5；p = 0.02）、耻骨弓骨折（OR：3.9；95%CI：1.5 - 9.7；p = 0.003）及既往尿道成形术（OR：4.2；95%CI：1.8 - 10.1；p = 0.001）是独立预测因素。在事件发生时间分析中，相同的预测因素具有显著性。列线图在当前数据及验证后的区分度分别为77.3%和75%。
球部尿道近端的位置及再次行尿道成形术可预测PFUI行PU术后再次干预的需求。该列线图可在术前用于患者咨询和手术规划。
