Analysis of the urethral stricture score and patient-related factors as predictors of outcomes following oral mucosal graft urethroplasty

Objective:The complexity of urethral strictures can predict outcomes following urethroplasty.The previously described urethral stricture score(U score)considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty,but not considered patient-related factors for the same.We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty.Methods:We retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months.Baseline patient characteristics and stricture-related parameters were noted.The U score was calculated for all patients which consisted of the length,location,number,and etiology of stricture.Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence.Results:The mean follow-up of patients was 15 months.Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up.The Charlson Comorbidity Index,history of previous intervention,length of strictures,location of strictures,number of strictures,history of smoking,and etiology were independent predictors of recurrence following urethroplasty.Based on these parameters,we formulated the modified U score(MU score).The scores ranged from 0 to 6 and a score of>2 was found to be predictive of recurrence.On comparing receiver operating characteristic curves for both scores by the DeLong test,the MU score had larger area under the curve than the U score.Conclusion:The MU scoring system is the first of its kind attempt taking into consideration both patient-and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.

Stricture Free Survival after Urethroplasty: A 6-Year Malaysian Referral Centre Experience

Background: Urethroplasty is the gold standard for treatment for urethral strictures. We describe our results of urethroplasty and analyse the risk factors associated with stricture recurrence and stricture-free survival. Methods: A retrospective review of urethroplasty surgery carried out from 2016-2022. Patient records were analysed to obtain demographics, clinical, pathological and outcome data. Success of surgery is defined as postoperative Qmax > 15 ml/s or absence of any instrumentation of urethra such as urethral dilatation, after removal of urethral indwelling catheter. Results: A total of 66 patients who fulfilled the inclusion criteria were selected. Mean age was 43.8. Mean follow up was 27.2 ± 21.8 months. Stricture recurred in 18 patients (27.3%). Estimated stricture free survival time was 59.6 months (95% CI: 50.87 - 68.37). Previous surgical history for stricture was found to be predictive of stricture recurrence. After adjusting for age, BMI, aetiology of stricture and stricture length, previous surgical history had a risk of stricture recurrence approximately three times higher compared to those without. Conclusion: Previous surgical intervention for urethral stricture was found to be the most significant factor for stricture recurrence. We strongly advocate that the first curative surgery done for urethral strictures should be done in high volume centres and by experienced reconstructive urologists.

Evaluation of the Quality of Micturition in Patients Who Underwent Anastomotic Urethroplasty at the Yaounde Central Hospital, Cameroon

Introduction: Radiological investigation which is the gold standard to perform following anastomotic urethroplasty in order to evaluate the quality of micturition is costly. In our context, due to financial limitations, reconstructive urologists prefer to use the uroflowmetry in order to assess the micturition post-surgery. Therefore, the objective of the study was to assess the quality of micturition using the uroflowmetry after anastomotic urethroplasty. Methodology: We conducted an 11-year retrospective review (1st January 2006-31st December 2017) and a cross-sectional descriptive observational study for a period of 8 months (November 2017-June 2018) at the Urology and Andrology Department of the Yaounde Central Hospital (YCH) of patients who were diagnosed with urethral stenosis and underwent an anastomotic urethroplasty at the YCH. We excluded patients who had incomplete files, patients lost to follow-up and did not do pre-operative uroflowmetry. Quality of micturition was evaluated using a uroflowmetry. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: We had a sample of 60 patients. The mean age was 42 ± 5 years with extremes ranging from 20 to 76 years. Twenty-seven (27) patients, or 45%, had no post-operative complications, and those who did had a urinary tract infection (26.70%). In our series, we had 82% excellent results (patient satisfied with his urination with bell-shaped urinary stream and urinary flow greater than or equal to 15 ml/sec);15% good results (patient with moderate dysuria with average urinary stream and urinary flow between 10 and 14.9 ml/sec) and 3% poor results (severe dysuria with urinary flow less than 10 ml/sec, urinary retention or urinary incontinence). Based on these results we can say that the success rate in our series was 97%. 96.70% of patients were satisfied against 3.3% who were not. Conclusion: Anastomotic urethroplasty is the gold standard for the treatment of short urethral strictures. The results are good in the immediate and long term post-operative period. The use of the uroflowmetry as a screening tool for evaluating the quality of micturition after urethroplasty is effective.

Urethroplasty among Elderly Men, Surgical Techniques and Outcomes

Introduction: Urethroplasty remains the gold standard for the management of urethral stricture. However, the treatment of stricture disease in the elderly tends to be less invasive due to the presumption that they might not be able to stand long hours of surgery and might have higher rates of recurrence due to poor wound healing from microangiopathy. We present our experience with the outcomes of urethroplasty among elderly men seen at the Komfo Anokye Teaching Hospital from January 2012 to December 2021. Methods: This was a retrospective review of data captured in the urology database on all patients 65 years and above who underwent urethroplasty at the hospital over the study period. Data was obtained on patients’ demographics, stricture characteristics, urethroplasty technique, and outcome. A successful outcome was defined as peak flow rate > 15 mls/s, a patent urethra on retrograde urethrogram, patient satisfaction with urine stream, or restoration of the normal stream of urine with only one attempt at urethral calibration or internal urethrotomy postoperatively. Data was analyzed using PASW Statistics for Windows, Version 18.0. Results: Overall, 43 urethroplasties were done over the study period in elderly men. The age range was 65 to 87 years. The commonest aetiology was catheterization (62.79%) followed by urethritis (32.56%). Stricture length ranged from 0.5 cm to 16 cm with a mean of 3.93 cm. Most patients (60.46%) had bulbar urethral strictures. The repair methods employed were anastomotic urethroplasty (62.80%), fasciocutaneous flap (FCF) ventral onlay (13.95%), buccal mucosa graft (BMG) ventral onlay urethroplasty (4.65%), and staged urethroplasty (4.65%). Three of the patients (6.98%) had a combination of anastomotic and tissue transfer urethroplasty. The overall success rate was 88.37%. Complications included three surgical site infections, two urethral diverticula and one glans dehiscence. Conclusion: Elderly men tolerate urethroplasty well and the procedure should not be denied solely based on age.

Lingual mucosal graft urethroplasty 12 years later: Systematic review and meta-analysis

Objective:To evaluate the functional results and complications of the lingual mucosal graft(LMG)urethroplasty and to sum up the current state of the art of this surgical technique.Methods:A systematic search of PubMed and Scopus electronic databases was performed,according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)statement.Studies involving male patients treated with LMG urethroplasty for urethral stricture were included.Complete protocol is available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121.A meta-analysis comparing functional and long-term oral complication outcomes of LMG and buccal mucosal graft(BMG)was performed,calculating the odds ratio(OR)and 95%confidence interval(CI).Results:Twenty original articles were included in the qualitative analysis.Strictures of 1.5e16.5 cm have been treated with LMG urethroplasty,due to the improvement of harvesting technique and very low rate of long-term oral complications.Very good functional results have been reported by different authors for LMG urethroplasty,with lower rate of oral complications than BMG.The meta-analysis included six comparative studies involving 187 and 178 patients treated with LMG and BMG urethroplasty,respectively.An OR of 1.65(95%CI[0.95e2.87],I^2=0%)and 0.18(95%CI[0.03e1.26],I^2=68%)were found for LMG vs.BMG urethroplasty,in terms of success and oral complication rate,respectively.Conclusion:LMG urethroplasty can be reasonably considered a first choice technique for urethral stricture with very good results.Oral complications are temporary and minimally disabling,basically less than those for BMG,and depend mainly on the graft extent.

Men Urethra Strictures: Findings in Urethroplasties Care at the Andrology and Urology Department of Grand Yoff General Hospital in Dakar

Objectives: To report the experiment conducted at the HOGGY Urology department in the management of urethral stricture by urethroplasty, and to determine the factors that influence the results. Material and Method: We conducted a descriptive and analytical retrospective study based on the records of patients who underwent urethroplasty in the department, between February 2001 and September 2013. Results: Ninety-one (91) patients were enrolled. Urethroplasties prevalence was 0.83% of the surgical activity of the service. The mean age of patients was 39.83 years. Dysuria (30.77%) followed by pelvic trauma (28.57%) and urinary retentions (25.27%) was the main discovery mode. A periurethral coating was found in 32 patients. The infectious etiology accounted for 44% of cases. In 63% of cases, diagnostic was made by retrograde cystography. The penile urethra was the favorite seat of the UR in 70% of cases. The average length of the urethral stricture (US) was less than 1 cm in 41.17% of cases. The US was unique in more than half of the cases (58.33%). Anastomotic urethroplasty was the best surgical technique with 73.63% of patients. Postoperative morbidity involved 47 patients and was dominated by urinary infections (36 year old). The average duration of follow-up of operated patients was 29 months. After 6 months of follow-up, the best results were obtained with the termino-terminal urethroplasty technique with 62.5%. After a follow-up of 4 years, the success rate was 58.24%. The length of the stenosis and the allocation of gestures on the urethra were the two factors of failure. Conclusion: Stenosis is common in our regions. Treatment results are disappointing. Urethroplasty is the gold standard of surgical treatment and anastomotic urethroplasty gives better results.

The Role of Dilation and Internal Urethrotomy as a Risk Factor of Failure in Patients Who Undergoing One-Stage Bulbar Oral Graft Urethroplasty

Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.

Urothelial or oral mucosa cells for tissue-engineered urethroplasty: A critical revision of the clinical outcome

Objective:To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.Methods:We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase(OvidSP)through January,1990 to June,2018.We excluded studies based on titles that clearly were not related to the subject,studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals,and in the absence of autologous cultured epithelial cells.Studies were also excluded if they were not published in English,had no disease background and adequate follow-up.Finally,we search all relevant abstract presented at two of the main urological meetings in the last 10 years:European Association of Urology(EAU)and American Urological Association(AUA).Results:A total of six articles,reporting the clinical use of tissue-engineered techniques in humans,were fully reviewed in our review.The epithelial cells were harvested from the urethra(10 patients),the bladder(11 patients)and the mouth(104 patients).The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases,and in adults for posterior and anterior urethral strictures repair in 109 cases.Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair.Conclusion:One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair.The studies demonstrate a high degree of heterogeneity respect to epithelial cells(from urethra,bladder,and mouth),type of scaffold,etiology,site of urethral stricture,number of patients,follow-up and outcomes.

Tissue engineered indigenous pericardial patch urethroplasty: A promising solution to a nagging problem

Objective:Urethral stricture is a highly prevalent disease and has a continued ris-ing incidence.The global burden of disease keeps rising as there are significant rates of recur-rence with the existing management options with the need for additional repeat procedures.Moreover,the existing treatment options are associated with significant morbidity in the pa-tient.Long segment urethral strictures are most commonly managed by augmentation urethro-plasty.We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from ure-thral stricture disease.The decreased morbidity due to the avoidance of harvest of buccal mu-cosa,decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty.Methods:Nine patients with long segment anterior urethral strictures(involving penile and/or bulbar urethra and stricture length>4 cm)were included in the study after proper informed consent was obtained.Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique.Results:A total of nine patients underwent tissue engineered indigenous pericardial patch ur-ethroplasty for long segment urethral strictures,mostly catheter injury induced or associated with balanitis xerotica obliterans.Median follow-up was 8 months(range:2-12 months).Out of nine patients,eight(88.9%)were classifed as success and one(11.1%)was classified as fail-ure.Conclusion:Our study brings a product of tissue engineering,already being used in the cardio-vascular surgery domain,into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.

Penile Skin Flap Urethroplasty for Urethral Stenosis at SominéDOLO Hospital of Mopti (MALI)

Introduction: Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. Patients and method: This was a prospective and descriptive study of penile skin flap urethroplasty indicated for urethral stenosis between January 2014 and December 2019. Results: A total of 21 penile skin flap urethroplasties for urethral stenosis were performed. The average age was 38.6 years old. The stenosis was of sclero-inflammatory origin in 15 cases (71.43%). It was of bulbo-perineal, penile, and penile-bulbar topography in about a third each. A history of urethral surgery was reported in 80.95% of the cases. The average length of the stenosis was 6.8 cm. Mundy circular skin flap urethroplasty about 15 cases (71.43%), and Quartey rectangular skin penile flap urethroplasty about 6 cases (28.57%) were the surgical techniques performed. The postoperative follow-up was favorable in 19 cases (90.48%). Two cases of urethral fistula (9.52%) underwent the 2nd urethroplasty. Urination at 1 year was satisfactory. No relapse has been reported to date. However, 4 patients (19.04%) reported asthenic ejaculation, and 1 patient (4.76%) a marked decrease in sexual pleasure. Conclusion: This surgical technique is effective in terms of voiding when the surgical indications are well chosen. The sexual aspect must be taken into account and the intervention only offered to those who really need it.

Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision

Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The mean
standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.82
3.97 to 10.88
5.57);so did postvoid residual urine(71.12
74.98 mL to 15.00
28.30 mL),and maximum flow rate(7.88
1.72 mL/s to 25.82
5.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.

Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Evaluation of patient reported outcome measures post urethroplasty:Piloting a“Trifecta”approach

BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease.Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years.Patient reported outcome measure(PROM)questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.AIM To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.METHODS Our database of urethroplasty patients was searched to identify patients who had completed the original PROM.This is routinely requested to be completed at the 3-,6-and 12-mo mark.All patients are asked to complete the questionnaire and to bring it back to their next appointment.Our original PROM consists of the international prostate symptom score,the sexual health index measure and the Global Response Assessment.An abridged version of the questionnaire was derived focusing on urinary flow,sexual function and overall quality of life and consisted of three questions.RESULTS Sixty-six patients were included in our study.Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%.Compliance rates improved to 91%with the introduction of the modified PROM.No correlation between non-compliance and patient factors were found.There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.CONCLUSION We recommend the use of PROMs pre-and post-operatively to accurately determine the level of patient satisfaction.We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires.We propose a simplistic version aimed at the“Trifecta”of urethroplasty comprising of three questions focusing each on urinary flow,sexual function and quality of life.Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.

One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias

Objective To report the treatment of perineal hypospadias with one - stage urethroplaty with circumferential vascular pedicle preputial island flap. Methods A circumferential incision was made proximal to the cprona and the urethral plate to correct chordee. A U - shaped skin incision was then made surrounding the meatus。

术前大肠杆菌培养阳性对尿道狭窄成形术后感染及发热的影响

目的 探究大肠杆菌相较其他病原体感染,是否增加尿道成形术后的手术部位感染以及术后发热。方法 采用回顾性队列研究的方式,纳入华西医院泌尿外科2011-2019年接受尿道狭窄段切除和端端吻合术来治疗尿道球部或后尿道狭窄的患者共506例,按术后是否发生手术部位感染(surgical site infection,SSI)和术后发热(postoperative fever,POF)分别分为SSI组(19例)和非SSI组(487例),POF组(61例)和非POF组(445例);采用多元Logistic回归分析与LASSO算法筛选潜在的危险因素;按照术前尿培养结果将患者分为大肠杆菌感染组(80例)和其他病原体感染组(222例),通过倾向评分匹配减少潜在偏倚后(匹配后大肠杆菌组:48例;其他病原体组:192例),比较大肠杆菌感染组与其他病原体感染组在手术部位感染和术后发热方面的差异。结果 在多元Logistic回归分析与LASSO算法中,术前尿培养阳性是预测手术部位感染(P=0.012)和术后发热(P<0.01)的独立危险因素,在302例术前尿培养阳性的患者中,大肠杆菌感染比例位居第一(26.5%)。倾向评分匹配处理后,大肠杆菌组与其他病原体组的手术部位感染的比例分别为29.2%和2.1%(P<0.01)。与其他病原体感染组相比,大肠杆菌感染组的术后发热比例也较高(27.1%vs 13.5%,P=0.02)。结论 与其他病原体感染相比,术前大肠杆菌感染会增加尿道成形术后的手术部位感染、术后发热风险。

男性尿道狭窄患者行尿道成形术治疗期间疾病体验的质性研究

目的 深入了解男性尿道狭窄患者行尿道成形术治疗期间的患病体验和心理感受。方法 采用质性研究中描述性现象学研究法,于2022年11月-2023年1月对13例上海市某三级甲等综合医院泌尿外科尿道狭窄患者进行深入访谈,借助Nvivo 11.0软件管理访谈资料,采用Colaizzi 7步分析法进行归纳分析并提炼主题。结果 共提炼出4个主题及9个亚主题:不良生理体验(排尿方式改变的不适、疼痛)、消极心理感知(遗憾和不满、对预后不确定的担忧)、面临诸多困境(求医历程曲折、夫妻关系破裂、频繁诊治与工作的矛盾)、需求与希望(对最佳医疗条件的需求、希望获得多层次信息支持)。结论 尿道狭窄患者行尿道成形术治疗期间面临多方面的困扰,医护人员应重视患者的不良反应和内心需求,加强健康照护、提供信息支持和情感引导,促进家庭关系和谐,改善患者的身心健康。

男性尿道狭窄病因及治疗方式10年变化的单中心回顾分析

目的探讨近10年单中心男性尿道狭窄病因及治疗方法的变化趋势。方法收集北京积水潭医院泌尿外科2013年1月—2022年12月收治的940例男性尿道狭窄患者,按照收治时间将患者分别纳入2013—2017年组及2018—2022年组,对比分析两组患者的病因、狭窄部位及长度和治疗方式。结果940例男性尿道狭窄的病因分别为外伤447例(47.55%)、医源性损伤220例(23.40%)、特发性病因128例(13.62%)、硬化性苔藓样变78例(8.30%)、感染46例(4.89%)、其他病因21例(2.23%)。治疗方法分别为尿道成形术691例(73.51%)、尿道狭窄内切开122例(12.98%)、尿道扩张86例(9.15%)、耻骨上膀胱造瘘41例(4.36%)。前后5年对比分析显示,2018—2022年组外伤所致尿道狭窄的占比较2013—2017年组明显下降(41.71%vs.60.34%,P<0.001),而医源性损伤所占比例明显上升(26.05%vs.17.63%,P=0.005);2018—2022年组尿道成形术占比有所增多(75.66%vs.68.81%,P=0.027),尿道狭窄内切开术的应用占比显著下降(9.92%vs.19.66%,P<0.001);2018—2022年组与2013—2017年组比较,膜部尿道狭窄所占比例显著下降(26.98%vs.50.85%,χ^(2)=51.06,P<0.001),而阴茎段尿道狭窄(21.40%vs.7.80%,χ^(2)=26.37,P<0.001)及尿道外口狭窄(9.30%vs.4.75%,χ^(2)=5.80,P<0.001)所占比例明显增多。结论外伤是近10年男性尿道狭窄的主要原因,但占比呈下降趋势;医源性损伤已上升为男性尿道狭窄的第2大原因;采用尿道成形术治疗的患者比例显著增多,成为近5年男性尿道狭窄最主要的治疗方法。

尿道狭窄3种术式手术前后勃起功能状态的临床研究

目的:对3种术式治疗尿道狭窄患者手术前后勃起功能状态进行研究。方法:分别采用3种术式对126例尿道狭窄男性患者进行治疗。35例患者接受尿道狭窄部位阴茎皮瓣重建术,52例患者接受尿道端端吻合术,39例患者接受内窥镜下尿道内切开术。通过电话随访、面访方式,采用国际勃起功能指数问卷(IIEF-5)评分对每组患者术前、术后勃起功能的总体情况进行评价,同时利用夜间阴茎胀大实验(NPT)对患者进行诊断。结果:行尿道狭窄部位阴茎皮瓣重建术组IIEF-5评分术前与术后分别为(17.1±2.6)分和(13.5±4.5)分;行尿道端端吻合术组IIEF-5评分术前与术后分别为(17.1±3.0)分和(11.1±4.8)分;行尿道内切开术组IIEF-5评分术前与术后分别为(17.6±2.2)分和(14.5±4.4)分。与术前相比,3组患者术后IIEF-5评分均显著下降,其差异具有统计学意义(P<0.05)。上述3种术式术后勃起功能障碍发生率分别为8.57%(3/35)、26.92%(14/52)、10.26%(4/39),尿道端端吻合术显著高于其他2种术式(P均<0.05)。结论:3种术式治疗尿道狭窄术后IIEF-5评分均有所下降,与尿道端端吻合术相比,尿道狭窄部位阴茎皮瓣重建术与尿道内切开术术后勃起功能障碍的发生率较低,应注重对适宜术式的选择以确保对患者性功能的有效保护。

尿道板纵切卷管尿道成形术治疗尿道下裂810例报告

目的评价尿道板纵切卷管尿道成形治疗尿道下裂临床疗效。方法回顾分析该院2002年3月~2011年1月接受尿道板纵切卷管尿道成形治疗的810例尿道下裂患者临床资料。手术年龄1~17岁,平均2.1岁,均采用尿道板纵切卷管成形法。结果术中尿道下裂程度按Duckett分型：前型316例（39.0%）、中间型348例（43.0%）、后型146例（18.0%）。阴茎下弯程度按照Donnahoo分级,将尿道下裂阴茎下弯程度分为0~4级。随访6月至2年,746例手术一次成功（92.1%）,150例3级阴茎下弯者采用阴茎背侧白膜折叠术纠正完成手术,新建尿道口位于阴茎头部,阴茎外观类似于包皮环切术后形态。术后并发尿道口狭窄11例（1.4%）,9例经再手术治疗后治愈,2例行尿道扩张后治愈。并发尿瘘49例（6.0%）,39例经再手术修补治愈。尿道憩室4例（0.5%）,均经手术治疗后治愈。结论尿道板纵切卷管尿道成形术适合于大多数尿道下裂患者,阴茎重度弯曲者若需采用尿道板纵切卷管尿道成形术则需行背侧海绵体折叠术。