球部尿道狭窄是一种单一且统一的疾病吗?

Tadashi Tabei, A. Horiguchi, M. Shinchi, Y. Hirano, K. Ojima, Keiichi Ito, R. Azuma
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摘要

目的:近端和远端球部尿道狭窄(BUS)具有不同的疾病特征,尽管被视为一种疾病,但需要不同的治疗策略。为了明确两者的区别,我们对数据库进行了分析,区分了两种类型的 BUS。方法我们回顾性审查了 2004 年 8 月至 2022 年 3 月期间在日本国防医学院接受尿道成形术的 196 例 BUS 患者的数据。我们根据狭窄段将患者分为近端组(第 1 组)和远端组(第 2 组),并比较了各组患者的背景和手术技术。我们使用多变量逻辑回归分析评估了狭窄段是否是替代尿道成形术选择的独立预测因素。复发率采用 Kaplan-Meier 法和对数秩检验进行计算和比较。结果显示与第 2 组相比,第 1 组患者的管腔不淤塞率较低(73% 对 94%,P = 0.020),狭窄长度明显较短(10 mm 对 23 mm,P < 0.001),更多是由外部创伤引起(47% 对 26%,P = 0.010)。逻辑回归分析表明,狭窄段(远端)(p < 0.001)、狭窄长度(≥20 毫米)(p < 0.001)、先前经尿道手术≥2 次(p = 0.030)和管腔不通畅(p = 0.020)是替代尿道成形术的独立预测因素。然而,两组患者的复发率(p = 0.18)并无显著差异。结论:近端和远端 BUS 的解剖特点和病因大不相同,需要不同的重建技术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is the Bulbar Urethral Stricture a Single and Uniform Disease?
Objectives: Proximal and distal bulbar urethral strictures (BUS) have different disease characteristics and require different treatment strategies despite being regarded as a single condition. To clarify the differences, we analyzed our database by distinguishing the two types of BUS. Methods: We retrospectively reviewed the data of 196 patients with BUS who underwent urethroplasty at the National Defense Medical College (Japan) between August 2004 and March 2022. We divided patients into proximal (group 1) or distal (group 2) groups based on the stricture segment and compared patient background and surgical techniques for each group. We assessed whether the stricture segment was an independent predictive factor for substitution urethroplasty selection using multivariate logistic regression analysis. The recurrence rates were calculated and compared using the Kaplan–Meier method and log-rank test, respectively. Results: Patients in group 1 had a less frequent non-obliterated lumen (73% vs. 94%, p = 0.020) and significantly shorter strictures (10 mm vs. 23 mm, p < 0.001) more frequently caused by external traumas (47% vs. 26%, p = 0.010) than those in group 2. Logistic regression analysis revealed that the stricture segment (distal) (p < 0.001), stricture length (≥20 mm) (p < 0.001), ≥2 prior transurethral procedures (p = 0.030), and a non-obliterated lumen (p = 0.020) were independent predictive factors for substitution urethroplasty. However, the recurrence rate (p = 0.18) did not significantly differ between the two groups. Conclusions: Proximal and distal BUS have substantially different anatomical characteristics and etiologies and require different reconstructive techniques.
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