Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
J Urol. 2024 Nov;212(5):738-748. doi: 10.1097/JU.0000000000004169. Epub 2024 Aug 2.
There is a paucity of long-term objective and patient-reported outcomes after definitive perineal urethrostomy for complex urethral strictures. Our objective is to determine comprehensive long-term success of perineal urethrostomy with our 15-year experience at a reconstructive referral center.
Patients who underwent perineal urethrostomy between 2009 and 2023 were identified. A comprehensive long-term follow-up was conducted, evaluating both objective outcomes (retreatment-free survival) and subjective outcomes through the use of validated questionnaires. Additionally, to provide further context for our findings, we conducted a scoping review of all studies reporting outcomes following perineal urethrostomy.
Among 76 patients, 55% had iatrogenic strictures, with 82% previously undergoing urethral interventions. At a median follow-up of 55 months, retreatment-free survival was 84%, with 16% of patients experiencing perineal urethrostomy recurrent stenosis. Patient-reported outcomes revealed a generally satisfactory voiding function (Urethral Stricture Surgery Patient-Reported Outcome Measure Lower Urinary Tract Symptoms score) and continence (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form), with median scores of 4 (range 0-24) and 0 (range 0-21), but with bimodal distributions of sexual function scores (median International Index of Erectile Function-Erectile Function domain: 3.5; median Male Sexual Health Questionnaire-Ejaculation Scale: 21). Treatment satisfaction was very high with a median International Consultation on Incontinence Questionnaire-Satisfaction outcome score of 21 (range 0-24). The scoping review revealed varying success rates ranging from 51% to 95%, highlighting difficulties in comparison due to variable success definitions and patient case mix.
Perineal urethrostomy provides effective treatment for complex anterior urethral strictures, with high patient satisfaction, preserved continence function, and favorable voiding outcomes. It presents a viable option for older and comorbid patients, especially after thorough counseling on expected outcomes and potential risks.
对于复杂尿道狭窄的确定性经会阴尿道吻合术，缺乏长期的目标和患者报告的结局。我们的目标是确定在我们的重建转诊中心 15 年的经验后，经会阴尿道吻合术的全面长期成功率。
确定了 2009 年至 2023 年期间接受经会阴尿道吻合术的患者。通过使用经过验证的问卷进行全面的长期随访，评估了客观结局（无治疗复发生存）和主观结局。此外，为了提供我们研究结果的背景信息，我们对所有报告经会阴尿道吻合术后结局的研究进行了范围综述。
在 76 名患者中，55%为医源性狭窄，82%以前接受过尿道干预。在中位随访 55 个月时，无治疗复发生存为 84%，16%的患者发生经会阴尿道吻合术后狭窄复发。患者报告的结局显示，排尿功能（尿道狭窄手术患者报告的结局测量下尿路症状评分）和控尿功能（国际尿失禁咨询问卷-尿失禁简短问卷）一般满意，中位数分别为 4 分（范围 0-24 分）和 0 分（范围 0-21 分），但性功能评分呈双峰分布（中位数国际勃起功能指数-勃起功能域：3.5；中位数男性性健康问卷-射精量表：21）。治疗满意度非常高，国际尿失禁咨询问卷-满意度结局评分中位数为 21 分（范围 0-24 分）。范围综述显示，成功率从 51%到 95%不等，由于成功定义和患者病例组合的差异，使得比较困难。
经会阴尿道吻合术为复杂前尿道狭窄提供了有效的治疗方法，患者满意度高，保留了控尿功能，排尿结局良好。对于年龄较大和合并症较多的患者，特别是在充分告知预期结局和潜在风险后，这是一种可行的选择。
