Santiago Javier E, Gross Michael D, Accioly João Pedro, Voelzke Bryan B, Breyer Benjamin N, Khouri Roger K, DeWitt-Foy Molly E, Angermeier Kenneth W, Wood Hadley M
Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, Ohio, USA.
Spokane Urology, Spokane, Washington, USA.
BJU Int. 2025 Feb;135(2):303-309. doi: 10.1111/bju.16566. Epub 2024 Oct 21.
To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics.
Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses.
A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group.
This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.
描述腹侧覆盖颊黏膜移植尿道成形术（vBMG）治疗球部尿道狭窄疾病（USD）的长期成功率，评估患者报告的术后满意度和决策后悔程度，并确定影响患者报告指标的临床因素。
联系2003年至2022年在克利夫兰诊所接受过球部USD的vBMG治疗的患者，并进行简短的结构化访谈。收集狭窄复发情况和二次手术需求、基线人口统计学数据以及患者报告的结局调查。调查包括决策后悔量表（DRS）、尿道狭窄症状影响量表（USSIM）和10项患者报告结局测量信息系统简表1.2版（PROMIS-10）。对临床结局和调查回复进行描述性、单变量和多变量分析。
共有104名患者记录了回复。调查时患者的中位年龄为49岁，中位随访时间为7.4年。移植物的中位长度为5厘米，38%的患者接受了部分厚度增强吻合尿道成形术。随访时，10名患者接受了二次手术。12%的患者在DRS上有中度至重度后悔，且后悔程度越高与复发相关。PROMIS-10全球健康T评分的平均身体和心理健康得分分别为52分和53分。USSIM总得分的平均值为56分。发现USSIM和DRS得分之间存在显著相关性，DRS得分越高和复发对USSIM得分有负面影响。在中度至重度DRS组中，所有领域的USSIM评分均显著更差。
这项研究表明，基于新出现的且经过验证的患者报告结局指标，vBMG治疗球部USD在延长随访期时具有较高的成功率和患者报告的满意度。
