Center for Urethral and Genitalia Reconstructive Surgery, Humanitas Cellini, Via Benvenuto Cellini 5, 10126, Turin, Italy.
Department of Urology, University of Modena and Reggio Emilia, Via Università 4, 41121, Modena, Italy.
World J Urol. 2024 Mar 7;42(1):123. doi: 10.1007/s00345-024-04795-8.
Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU).
From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo.
Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm.
SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.
小肠黏膜下层（SIS）移植物尿道成形术已被用于降低颊黏膜发病率并简化手术过程。第一批发表的系列研究随访时间短、患者选择不均一且缺乏对照组。我们的目的是在一项倾向评分匹配队列研究中报告 13 年的治疗结果，该研究比较了 SIS（SISU）或颊黏膜（BMU）用于球部尿道成形术的效果。
从我们的 1132 例球部尿道成形术的机构数据库中，我们使用无替换的最近邻法进行倾向评分匹配，生成 25 例 BMU 和 25 例 SISU 的研究样本。将任何尿道成形术后的治疗都定义为失败。使用生存分析来分析 156 个月数据截止时治疗失败的发生。
匹配结果除了 SIS 组的随访时间稍长外，两组间的偏倚完全得到纠正。BMU 和 SISU 在 156 个月时的累积治疗成功率分别为 83.4%和 68%。多变量 Cox 回归分析显示，SIS 移植物、既往尿道扩张术、狭窄长度和术后较短时间（导管拔出后 2 个月内）的 Qmax 是失败的预测因素。在 SISU 中，狭窄长度的影响更为显著，Cox 模型估计的生存概率在狭窄长度大于等于 3cm 的患者中低于 80%。
与 BM 相比，SIS 的结果较差，但在无法进行 BM 移植时可能仍然有用。对于 SISU，与 BMU 相似的成功率的最佳候选者是狭窄长度小于 3cm 的患者，优选没有 DVIU 病史的患者。
