Surgical Management of Anterior Urethral Stricture: A 23-year Single-Center Study.

IF 2.7 Q2 UROLOGY & NEPHROLOGY
Research and Reports in Urology Pub Date : 2025-02-19 eCollection Date: 2025-01-01 DOI:10.2147/RRU.S507169
Yilong Guo, Ning Ma, Jiaxiong Zhang, Sen Chen, Pingping Liu, Zhe Yang, Yangqun Li
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引用次数: 0

Abstract

Purpose: Anterior urethral stricture is a common clinical condition in urology with significant socioeconomic impacts and is associated with high recurrence rates of and postoperative complications. However, the long-term outcome of surgical management of urethra stricture and the associated risk factors of stricture recurrence remain limited. We conducted a 23-year single-center retrospective study to evaluate the long-term surgical outcomes of anterior urethral strictures with different clinical characteristics and to study factors that contribute to stricture recurrence.

Methods: A retrospective study was conducted on 145 male patients diagnosed with anterior urethral stricture, who underwent meatotomy, anastomotic urethroplasty (AU), penile skin flap urethroplasty (PFU), single-stage buccal mucosa grafting (SSU), or multistage buccal mucosa grafting (MSU) between April 2000 and August 2023. We defined 100 months as the cut-off time point to distinguish short-term and long-term follow-up. Early surgical complications were scored using the Clavien-Dindo classification at 3 months. Patient-Reported Outcome Measure (PROM) was applied to evaluate surgical success. Risk factors for wound complications were evaluated using univariable and multivariable analysis.

Results: The overall mean stricture length was 2.3 ± 1.8 cm (a range of 0.3-7.0). Stricture locations were at the meatus, fossa navicularis, penile, bulbar, and multifocal in 15, 36, 79, 9, and 6. The short-term and long-term success rate for meatotomy, AU, PFU, SSU, and MSU were 70.0%/80%, 70.4%/62.5%, 77.8%/69.2%, 100%/75%, and 81.8%/66.7%, respectively. The early complications classified as Clavien grades I, II, III, IV, and V were 39, 5, 5, 0, and 0. The late complication rate in the short-term and long-term groups were 20.3% and 30.3% (p > 0.05). The satisfaction survey showed that 74.5% (108 of 145) patients were satisfied or very satisfied with the surgical result. There was no statistically significant difference in stricture-free survival among the five surgical groups (Log rank test: χ² = 3.83, p > 0.05). The binary univariate logistic regression analysis showed that stricture symptom duration (p < 0.05) and previous urethroplasty (p < 0.05) were independent predictors of surgery failure.

Conclusion: This long-term retrospective study on male anterior urethral stricture disease demonstrates that surgical management is an effective and functional treatment. However, the success rate of urethroplasty shows a declining trend with longer follow-up. Stricture symptom duration and previous urethroplasty carry a high risk of surgical failure.

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前尿道狭窄的外科治疗:一项23年的单中心研究。
目的:前尿道狭窄是泌尿外科常见的临床疾病,具有显著的社会经济影响,并与高复发率和术后并发症相关。然而,尿道狭窄手术治疗的长期结果和狭窄复发的相关危险因素仍然有限。我们进行了一项为期23年的单中心回顾性研究,以评估具有不同临床特征的前尿道狭窄的长期手术效果,并研究导致狭窄复发的因素。方法:回顾性分析2000年4月至2023年8月间,145例男性前尿道狭窄患者行切肉、吻合口尿道成形术(AU)、阴茎皮瓣尿道成形术(PFU)、单期颊黏膜移植术(SSU)、多期颊黏膜移植术(MSU)。我们将100个月作为截止时间点,以区分短期随访和长期随访。术后3个月采用Clavien-Dindo分级对早期手术并发症进行评分。采用患者报告结果测量(PROM)来评估手术成功。采用单变量和多变量分析评估伤口并发症的危险因素。结果:总平均狭窄长度为2.3±1.8 cm(范围0.3-7.0)。15、36、79、9和6的狭窄部位分别位于鼻道、小舟窝、阴茎、球茎和多灶。切肉、AU、PFU、SSU、MSU的近期和长期成功率分别为70.0%/80%、70.4%/62.5%、77.8%/69.2%、100%/75%、81.8%/66.7%。早期并发症分为Clavien I、II、III、IV、V级分别为39、5、5、0、0。短期组和长期组晚期并发症发生率分别为20.3%和30.3% (p < 0.05)。满意度调查显示,145例患者中有108例(74.5%)对手术效果满意或非常满意。5个手术组无狭窄生存率差异无统计学意义(Log rank检验:χ²= 3.83,p < 0.05)。二元单因素logistic回归分析显示,狭窄症状持续时间(p < 0.05)和既往尿道成形术(p < 0.05)是手术失败的独立预测因素。结论:对男性前尿道狭窄疾病的长期回顾性研究表明,手术治疗是有效和有效的治疗方法。然而,随着随访时间的延长,尿道成形术的成功率呈下降趋势。狭窄症状持续时间和既往尿道成形术是手术失败的高风险因素。
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来源期刊
Research and Reports in Urology
Research and Reports in Urology UROLOGY & NEPHROLOGY-
CiteScore
3.40
自引率
0.00%
发文量
60
审稿时长
16 weeks
期刊介绍: Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.
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