Bandini Marco, Joshi Pankaj, Bafna Sandeep, Yepes Christian, Alrefaey Ahmed, Longoni Mattia, Montorsi Francesco, Kulkarni Sanjay
Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India.
BJU Int. 2025 Oct;136(4):640-646. doi: 10.1111/bju.16796. Epub 2025 May 24.
To assess whether single-stage preputial spiral graft urethroplasty (PSGU) minimises panurethral stricture (PUS) recurrence, which often result from traditional multiple grafting for anterior urethral strictures exceeding 10 cm.
We prospectively collected 114 patients with PUS treated with single-stage PSGU across five centres in India, Colombia, Egypt, and Italy since May 2021. Preoperative assessment included physical examination, medical history, uroflowmetry, International Prostate Symptom Score (IPSS), five-item International Index of Erectile Function (IIEF-5), and urethrography. Intraoperative urethroscopy assessed stricture length and severity. Follow-up included uroflowmetry and patient-reported outcomes. Treatment success was defined as a maximum urinary flow rate (Q) >10 mL/s without symptoms. Outcomes were compared between teaching and fellows' institutions.
The median stricture length was 16 cm, with instrumentation as the most frequent aetiology (64.0%). The median (interquartile range [IQR]) operative time was 134 (123-142) min. Postoperative complications rate was 23.0%, mostly Clavien-Dindo Grade I. At a median (IQR) follow-up of 16 (7-24) months, the median Q significantly increased from 4.5 preoperatively to 24 mL/s postoperatively (P < 0.001), while the median IPSS decreased by 24.3 points (P < 0.001) and the median IIEF-5 score remained stable. Stricture recurrence occurred in 11 (9.6%) patients. No significant differences in patency/complications were found between teaching and fellows' institutions. Key PSGU limitations are intact prepuce and absence of active lichen sclerosus.
A single-stage PSGU effectively manages PUS, showing comparable outcomes across institutions with varying experience levels. This technique is ready for broader adoption in clinical practice, pending further studies to confirm its long-term efficacy.
评估单阶段包皮螺旋皮瓣尿道成形术（PSGU）是否能将全尿道狭窄（PUS）的复发率降至最低，这种狭窄通常是由传统的多次皮瓣移植治疗超过10厘米的前尿道狭窄所致。
自2021年5月起，我们在印度、哥伦比亚、埃及和意大利的五个中心前瞻性收集了114例接受单阶段PSGU治疗的PUS患者。术前评估包括体格检查、病史、尿流率测定、国际前列腺症状评分（IPSS）、五项国际勃起功能指数（IIEF-5）和尿道造影。术中尿道镜检查评估狭窄长度和严重程度。随访包括尿流率测定和患者报告的结果。治疗成功定义为最大尿流率（Q）>10毫升/秒且无症状。对教学机构和实习医生所在机构的结果进行了比较。
狭窄的中位长度为16厘米，器械操作是最常见的病因（64.0%）。中位（四分位间距[IQR]）手术时间为134（123 - 142）分钟。术后并发症发生率为23.0%，大多为Clavien-Dindo I级。在中位（IQR）随访16（7 - 24）个月时，中位Q值从术前的4.5显著增加至术后的24毫升/秒（P < 0.001），而中位IPSS下降了24.3分（P < 0.001），中位IIEF-5评分保持稳定。11例（9.6%）患者出现狭窄复发。教学机构和实习医生所在机构在通畅率/并发症方面未发现显著差异。PSGU的主要局限性是包皮完整和无活动性硬化性苔藓。
单阶段PSGU能有效治疗PUS，在不同经验水平的机构中显示出相似的结果。在进一步研究证实其长期疗效之前，该技术已准备好在临床实践中更广泛地应用。
