Ross Hengel, Alex Vanni, Brad Erickson, Sean Elliott, Ben Breyer, Jill C Buckley, Josh Broghammer, Bryan Voelzke, Jeremy Myers, Keith Rourke
{"title":"硬苔性阴茎尿道狭窄的多机构手术分析：建立单阶段尿道成形术作为主要治疗选择。","authors":"Ross Hengel, Alex Vanni, Brad Erickson, Sean Elliott, Ben Breyer, Jill C Buckley, Josh Broghammer, Bryan Voelzke, Jeremy Myers, Keith Rourke","doi":"10.1097/JU.0000000000004434","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Ideal treatment of lichen sclerosus (LS)-induced penile urethral strictures (PUS) remains elusive. The objective of this study was to compare multi-institutional outcomes of single-stage urethroplasty (SSU) with oral mucosal graft, staged urethroplasty, and perineal urethrostomy (PU) for treatment of LS-induced PUS.</p><p><strong>Materials and methods: </strong>Multi-institutional analysis was performed at 9 centers on men undergoing SSU, staged urethroplasty, or PU for LS-induced PUS. Meatal strictures (<2 cm), bulbar urethral involvement, and panurethral strictures (>10 cm) were excluded. The primary outcome was recurrence-free status on follow-up assessment. Secondary outcomes included 90-day complications (Clavien ≥ 2), erectile dysfunction, chordee, and urethrocutaneous fistula.</p><p><strong>Results: </strong>Two hundred thirty-one patients were included with a median stricture length of 5 cm and median follow-up of 53 months among those without stricture recurrence. 1-, 5-, and 10-year stricture-free estimates were 90%, 80%, and 75%, respectively. 55% (127/231) underwent SSU with oral mucosal graft, 19% (44) staged urethroplasty, and 26% (60) underwent PU. On log-rank, there was no identifiable difference in stricture recurrence between techniques (<i>P</i> = .6) with 5-year stricture-free estimates of 82%, 76%, and 75%, respectively. On χ<sup>2</sup>, there was no significant difference in 90-day complications (7.1% vs 16% vs 8.3%; <i>P</i> = .2), erectile dysfunction (7.1% vs 4.5% vs 3.3%; <i>P</i> = .6), chordee (5.5% vs 6.8% vs 1.7%; <i>P</i> = .4), or urethrocutaneous fistula (2.4% vs 6.8% vs 0%; <i>P</i> = .09). On Cox regression, only obesity (BMI ≥ 35) was associated with stricture recurrence (HR, 2.31, 95% CI, 1.28-4.17; <i>P</i> = .006).</p><p><strong>Conclusions: </strong>Favorable comparative outcomes confirm SSU as a highly feasible treatment for LS-induced PUS in properly selected patients, especially when considering fewer surgeries required and preservation of an orthotopic meatus.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":" ","pages":"101097JU0000000000004434"},"PeriodicalIF":5.9000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Multi-Institutional Analysis of Surgery for Lichen Sclerosus-Induced Penile Urethral Stricture: Establishing Single-Stage Urethroplasty as a Primary Treatment Option.\",\"authors\":\"Ross Hengel, Alex Vanni, Brad Erickson, Sean Elliott, Ben Breyer, Jill C Buckley, Josh Broghammer, Bryan Voelzke, Jeremy Myers, Keith Rourke\",\"doi\":\"10.1097/JU.0000000000004434\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Ideal treatment of lichen sclerosus (LS)-induced penile urethral strictures (PUS) remains elusive. The objective of this study was to compare multi-institutional outcomes of single-stage urethroplasty (SSU) with oral mucosal graft, staged urethroplasty, and perineal urethrostomy (PU) for treatment of LS-induced PUS.</p><p><strong>Materials and methods: </strong>Multi-institutional analysis was performed at 9 centers on men undergoing SSU, staged urethroplasty, or PU for LS-induced PUS. Meatal strictures (<2 cm), bulbar urethral involvement, and panurethral strictures (>10 cm) were excluded. The primary outcome was recurrence-free status on follow-up assessment. Secondary outcomes included 90-day complications (Clavien ≥ 2), erectile dysfunction, chordee, and urethrocutaneous fistula.</p><p><strong>Results: </strong>Two hundred thirty-one patients were included with a median stricture length of 5 cm and median follow-up of 53 months among those without stricture recurrence. 1-, 5-, and 10-year stricture-free estimates were 90%, 80%, and 75%, respectively. 55% (127/231) underwent SSU with oral mucosal graft, 19% (44) staged urethroplasty, and 26% (60) underwent PU. On log-rank, there was no identifiable difference in stricture recurrence between techniques (<i>P</i> = .6) with 5-year stricture-free estimates of 82%, 76%, and 75%, respectively. On χ<sup>2</sup>, there was no significant difference in 90-day complications (7.1% vs 16% vs 8.3%; <i>P</i> = .2), erectile dysfunction (7.1% vs 4.5% vs 3.3%; <i>P</i> = .6), chordee (5.5% vs 6.8% vs 1.7%; <i>P</i> = .4), or urethrocutaneous fistula (2.4% vs 6.8% vs 0%; <i>P</i> = .09). On Cox regression, only obesity (BMI ≥ 35) was associated with stricture recurrence (HR, 2.31, 95% CI, 1.28-4.17; <i>P</i> = .006).</p><p><strong>Conclusions: </strong>Favorable comparative outcomes confirm SSU as a highly feasible treatment for LS-induced PUS in properly selected patients, especially when considering fewer surgeries required and preservation of an orthotopic meatus.</p>\",\"PeriodicalId\":17471,\"journal\":{\"name\":\"Journal of Urology\",\"volume\":\" \",\"pages\":\"101097JU0000000000004434\"},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2025-02-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JU.0000000000004434\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JU.0000000000004434","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
摘要：硬地衣（LS）致阴茎尿道狭窄的理想治疗方法尚不明确。本研究的目的是比较单阶段尿道成形术（SSU）与口腔黏膜移植（OMG）、阶段尿道成形术和会阴尿道造口术（PU）治疗LS诱导脓液的多机构疗效。方法：对9个中心接受SSU、分期尿道成形术或PU治疗LS性脓肿的男性患者进行多机构分析。排除金属狭窄（10 cm）。主要终点是随访评估的无复发状态。次要结局包括90天并发症（Clavien≥2）、勃起功能障碍、脊索和尿道瘘。结果：231例患者中位狭窄长度为5cm，无狭窄复发的患者中位随访53个月。1年、5年和10年无狭窄估计分别为90%、80%和75%。55%（127/231）患者行SSU伴OMG， 19%（44）分期行尿道成形术，26%（60）行PU。在log-rank上，两种技术之间的狭窄复发率没有明显差异（p=0.6）， 5年无狭窄估计分别为82%、76%和75%。卡方分析显示，90天并发症（7.1% vs. 16% vs. 8.3%;p=0.2）、勃起功能障碍(7.1% vs. 4.5% vs. 3.3%；P =0.6)；vs.1.7% 6.8%;P =0.4)或尿道瘘(2.4% vs. 6.8% vs. 0%；p = 0.09)。Cox回归分析显示，只有肥胖（BMI≥35）与狭窄复发相关(风险比2.31,95%CI 1.28-4.17；p = 0.006)。结论：良好的对比结果证实，在适当选择的患者中，单期尿道成形术是一种高度可行的治疗LS诱导脓液的方法，特别是考虑到所需手术次数减少和保留原位道。
Multi-Institutional Analysis of Surgery for Lichen Sclerosus-Induced Penile Urethral Stricture: Establishing Single-Stage Urethroplasty as a Primary Treatment Option.
Purpose: Ideal treatment of lichen sclerosus (LS)-induced penile urethral strictures (PUS) remains elusive. The objective of this study was to compare multi-institutional outcomes of single-stage urethroplasty (SSU) with oral mucosal graft, staged urethroplasty, and perineal urethrostomy (PU) for treatment of LS-induced PUS.
Materials and methods: Multi-institutional analysis was performed at 9 centers on men undergoing SSU, staged urethroplasty, or PU for LS-induced PUS. Meatal strictures (<2 cm), bulbar urethral involvement, and panurethral strictures (>10 cm) were excluded. The primary outcome was recurrence-free status on follow-up assessment. Secondary outcomes included 90-day complications (Clavien ≥ 2), erectile dysfunction, chordee, and urethrocutaneous fistula.
Results: Two hundred thirty-one patients were included with a median stricture length of 5 cm and median follow-up of 53 months among those without stricture recurrence. 1-, 5-, and 10-year stricture-free estimates were 90%, 80%, and 75%, respectively. 55% (127/231) underwent SSU with oral mucosal graft, 19% (44) staged urethroplasty, and 26% (60) underwent PU. On log-rank, there was no identifiable difference in stricture recurrence between techniques (P = .6) with 5-year stricture-free estimates of 82%, 76%, and 75%, respectively. On χ2, there was no significant difference in 90-day complications (7.1% vs 16% vs 8.3%; P = .2), erectile dysfunction (7.1% vs 4.5% vs 3.3%; P = .6), chordee (5.5% vs 6.8% vs 1.7%; P = .4), or urethrocutaneous fistula (2.4% vs 6.8% vs 0%; P = .09). On Cox regression, only obesity (BMI ≥ 35) was associated with stricture recurrence (HR, 2.31, 95% CI, 1.28-4.17; P = .006).
Conclusions: Favorable comparative outcomes confirm SSU as a highly feasible treatment for LS-induced PUS in properly selected patients, especially when considering fewer surgeries required and preservation of an orthotopic meatus.
期刊介绍：
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
