Alrefaey Ahmed, Anwar Mohamed Ahmed, Abdelmagid Mostafa Ezzeldeen, Tagrida Ibrahim Alaa Eldin, Elatreisy Adel, Fahim Ahmed
Urology Department, Faculty of Medicine, Al-Azhar university, Cairo, Egypt.
Sci Rep. 2025 Aug 12;15(1):29508. doi: 10.1038/s41598-025-14191-w.
To compare the outcomes of augmentation urethroplasty (AU) performed with either buccal mucosa graft (BMG) or penile skin graft (PSG) in managing long-segment anterior urethral strictures. A prospective randomized trial involved 98 patients diagnosed with anterior urethral stricture scheduled to AU between June 2022 and December 2024. Participants were randomly assigned to either the PSG or BMG arms. The comparison included patient demographics, clinicopathological characteristics of strictures, and surgical outcomes. The primary outcome was the success rate at 12 months. Secondary outcomes included functional parameters, such as the Urethral Stricture Surgery-Patient Related Outcome Measure (USS-PROM), the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF) Score, the Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), Q-max, and perioperative complications. The study arms were comparable regarding the preoperative parameters with a mean stricture length ± SD of 6.4 ± 2.3 and 7.9 ± 4.1 cm for PSG and BMG, respectively (p = 0.11). After a median follow-up of 20 months (12-30), the success rates of AU with PSG and BMG were comparable (93.2% v/s 97.9%, respectively; p = 0.346). There was no statistically significant difference in the IIEF (p = 0.8) and MSHQ-EJD (p = 0.22). The improvements in USS-PROM: LUTS domain (p = 0.19), USS-PROM: peeling voiding score (p = 0.62), IPSS (p = 0.43), and Q-max (p = 0.39) were comparable between the study arms. Clavien-Dindo grade I-III complications were 6.8 and 8.3% (p = 0.8), with patients' satisfaction of 90.9% and 93.8% (p = 0.5) for PSG and BMG, respectively. Kaplan-Meier survival analysis showed no statistically significant difference in stricture-free survival among both techniques (hazard ratio 1.19; p = 0.275). Our study demonstrates that PSG and BMG techniques for augmentation anterior urethroplasty have high and comparable success rates, with equal patient satisfaction and similarly low morbidity. Neither technique negatively affected sexual or ejaculatory functions.
比较采用颊黏膜移植（BMG）或阴茎皮肤移植（PSG）进行尿道成形术（AU）治疗长段前尿道狭窄的疗效。一项前瞻性随机试验纳入了98例2022年6月至2024年12月期间被诊断为前尿道狭窄并计划接受AU治疗的患者。参与者被随机分配至PSG组或BMG组。比较内容包括患者人口统计学资料、狭窄的临床病理特征及手术结果。主要结局为12个月时的成功率。次要结局包括功能参数，如尿道狭窄手术患者相关结局测量量表（USS-PROM）、国际前列腺症状评分（IPSS）、国际勃起功能指数（IIEF）评分、射精功能障碍男性性健康问卷（MSHQ-EJD）、最大尿流率（Q-max）及围手术期并发症。研究组在术前参数方面具有可比性，PSG组和BMG组的平均狭窄长度±标准差分别为6.4±2.3 cm和7.9±4.1 cm（p = 0.11）。中位随访20个月（12 - 30个月）后，PSG组和BMG组AU的成功率相当（分别为93.2%和97.9%；p = 0.346）。IIEF（p = 0.8）和MSHQ-EJD（p = 0.22）无统计学显著差异。研究组间USS-PROM：下尿路症状领域（p = 0.19）、USS-PROM：排尿剥脱评分（p = 0.62）、IPSS（p = 0.43）及Q-max（p = 0.39）的改善情况相当。PSG组和BMG组Clavien-Dindo I - III级并发症分别为6.8%和8.3%（p = 0.8），患者满意度分别为90.9%和93.8%（p = 0.5）。Kaplan-Meier生存分析显示，两种技术在无狭窄生存方面无统计学显著差异（风险比1.19；p = 0.275）。我们的研究表明，PSG和BMG技术用于增强型前尿道成形术的成功率高且相当，患者满意度相同，发病率同样较低。两种技术均未对性功能或射精功能产生负面影响。
