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.
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.