Wang Jie, Wang Jianwei, Xia Haizhui, Xu Xiao, Zhai Jianpo, He Feng, Huang Guanglin, Li Guizhong
Department of Urology, Beijing Jishuitan Hospital, Capital Medical Universitay, Beijing 100035, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Dec 18;56(6):1075-1082. doi: 10.19723/j.issn.1671-167X.2024.06.021.
To evaluate the surgical methods for treating distal urethral stricture.
The clinical data of 80 patients with distal urethral stricture in Beijing Jishuitan Hospital, Captial Medical University between January 2018 and December 2022 were retrospectively collected. Including male genital lichen sclerosus (MGLS) 33 cases, iatrogenic injury 25 cases, postoperative hypospadias 12 cases, and other causes such as trauma 10 cases. Among these cases, strictures involved the urethral meatus in 54 instances, of which 38 were treated with meatotomy (MO), 7 with penile skin flap urethroplasty (PSFU), and 9 with oral mucosa graft urethroplasty (OMGU). There were also 26 instances where strictures involved both the navicular fossa and meatus; one case underwent PSFU while 25 underwent OMGU. Based on different surgical methods used for treatment purposes we divided the patients into MO group, PSFU group and OMGU group. The age of the three groups was (48.8±20.0) years, (53.3±21.8) years and (44.5±16.4) years. The mean±SD body mass index (BMI) was (28.6±3.9) kg/m, (29.6±3.2) kg/m and (29.2±4.8) kg/m. The preoperative maximum flow rate was (5.8±2.3) mL/s, (6.8±2.4) mL/s and (5.7±3.1) mL/s.
All the operations were successfully completed without Clavien Ⅲ or Ⅳ complications. The median length of strictures (measured intraoperatively) in the three groups were 1.1 (1.0, 1.6), 1.5 (1.1, 2.0) and 4.0 (2.5, 5.0) cm. The median operation time was 60.0 (60.0, 75.0), 85.0 (75.0, 112.5) and 180.0 (75.0, 330.0) min. The median estimated blood loss was 5.0 (2.0, 10.0), 15.0 (5.0, 42.5) and 180.0 (135.0, 216.3) mL. The median postoperative hospital stay was 3.5 (2.0, 5.0), 6.5 (3.5, 7.0) and 7.5 (7.0, 11.3) days. The median follow-up duration was 40.0 (26.3, 57.3), 55.0 (18.8, 62.8) and 52.5 (30.5, 64.0) months. The median postoperative maximum flow rate was 18.3 (15.5, 19.8), 19.2 (16.1, 20.1) and 17.2 (14.2, 19.6) mL/s. Among the 38 patients with MO, 33 cases had normal urination without reintervention, and 5 cases experienced recurrent strictures and required regular urethral dilation. Among the 8 patients with PSFU, 7 cases had normal urination without reintervention, and one case developed a urinary fistula, for which intervention was recommended but the patient opted to maintain the status quo. Among the 34 patients with OMGU, 28 cases had normal urination without reintervention. There were 6 instances of stenosis recurrence, with 5 cases requiring regular urethral dilations and one case requiring reconstructive surgery. The overall success rate of operation was 85.0%, and the reintervention rate was 15.0%. Statistical analysis revealed significant differences in etiologies among the three groups (=0.002), as well as in stricture locations ( < 0.001), length of strictures ( < 0.001), operation time ( < 0.001), estimated blood loss ( < 0.001) and postoperative hospital stays ( < 0.001). However, no significant differences were observed in terms of age, BMI, history of previous urethral stricture surgeries, preoperative maximum flow rate, follow-up duration, postoperative maximum flow rate and reintervention rate. Univariate and multivariate Logistic regression analyses indicated that a history of previous urethral stricture surgeries was a risk factor for postoperative reintervention (=0.026).
MO and PSFU are primarily suitable for treating short-segment (≤1.5 cm) distal penile urethral strictures, whereas OMGU is more appropriate for longer segment strictures. MO and OMGU can both be utilized in managing MGLS cases. PSFU and OMGU are more conducive to improving the appearance of the urethral meatus. The success rate of surgical management of distal penile urethral stricture is 85.0%, 15.0% of the patients still require surgical intervention after surgery, and having history of previous urethral stricture surgeries is a risk factor for postoperative reintervention.
评估治疗尿道远端狭窄的手术方法。
回顾性收集2018年1月至2022年12月首都医科大学附属北京积水潭医院80例尿道远端狭窄患者的临床资料。其中男性生殖器硬化性苔藓（MGLS）33例，医源性损伤25例，术后尿道下裂12例，外伤等其他原因10例。这些病例中，54例狭窄累及尿道口，其中38例行尿道口切开术（MO），7例行阴茎皮瓣尿道成形术（PSFU），9例行口腔黏膜移植尿道成形术（OMGU）。另有26例狭窄累及舟状窝和尿道口；1例行PSFU，25例行OMGU。根据治疗所用的不同手术方法将患者分为MO组、PSFU组和OMGU组。三组患者年龄分别为（48.8±20.0）岁、（53.3±21.8）岁和（44.5±16.4）岁。平均±标准差体重指数（BMI）分别为（28.6±3.9）kg/m、（29.6±3.2）kg/m和（29.2±4.8）kg/m。术前最大尿流率分别为（5.8±2.3）mL/s、（6.8±2.4）mL/s和（5.7±3.1）mL/s。
所有手术均顺利完成，无ClavienⅢ或Ⅳ级并发症。三组术中测量的狭窄中位数长度分别为1.1（1.0，1.6）cm、1.5（1.1，2.0）cm和4.0（2.5，5.0）cm。中位手术时间分别为60.0（60.0，75.0）min、85.0（75.0，112.5）min和180.0（75.0，330.0）min。中位估计失血量分别为5.0（2.0，10.0）mL、15.0（5.0，42.5）mL和180.0（135.0，216.3）mL。术后中位住院时间分别为3.5（2.0，5.0）天、6.5（3.5，7.0）天和7.5（7.0，11.3）天。中位随访时间分别为40.0（26.3，57.3）个月、55.0（18.8，62.8）个月和52.5（30.5，64.0）个月。术后中位最大尿流率分别为18.3（15.5，19.8）mL/s、19.2（16.1，20.1）mL/s和17.2（14.2，19.6）mL/s。38例行MO的患者中，33例排尿正常无需再次干预，5例出现狭窄复发需定期尿道扩张。8例行PSFU的患者中，7例排尿正常无需再次干预，1例发生尿瘘，建议干预但患者选择维持现状。34例行OMGU的患者中，28例排尿正常无需再次干预。有6例狭窄复发，5例需定期尿道扩张，1例需再次手术。手术总体成功率为85.0%，再次干预率为15.0%。统计分析显示三组病因存在显著差异（=0.002），狭窄部位（<0.001）、狭窄长度（<0.001）、手术时间（<0.001）、估计失血量（<0.001）和术后住院时间（<0.001）也存在显著差异。然而，在年龄、BMI、既往尿道狭窄手术史、术前最大尿流率、随访时间、术后最大尿流率和再次干预率方面未观察到显著差异。单因素和多因素Logistic回归分析表明，既往尿道狭窄手术史是术后再次干预的危险因素（=0.026）。
MO和PSFU主要适用于治疗短段（≤1.5 cm）阴茎尿道远端狭窄，而OMGU更适用于长段狭窄。MO和OMGU均可用于治疗MGLS病例。PSFU和OMGU更有利于改善尿道口外观。阴茎尿道远端狭窄手术治疗成功率为85.0%，15.0%的患者术后仍需手术干预，既往尿道狭窄手术史是术后再次干预的危险因素。
