Long-term followup of bulbar end-to-end anastomosis: A retrospective analysis of 153 patients in a single center experience
Long-term followup of bulbar end-to-end anastomosis: A retrospective analysis of 153 patients in a single center experience
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DOI：
10.1016/j.juro.2007.08.018
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发表时间：
2007-12-01
影响因子：
6.6
通讯作者：
Lazzeri, Massimo
中科院分区：
文献类型：
--
作者：
Barbagli, Guido;De Angelis, Michele;Lazzeri, Massimo
目的：我们进行了回顾性评价和统计分析的结果，在患者接受球端端吻合术。材料和方法：我们回顾了153例，平均年龄为39岁，1988年至2006年接受球端端吻合术。平均随访68个月。原因不明（62.7%）、导尿管（14.4%）、会阴钝伤（11.7%）、器械（9.8%）、放疗（0.7%）和感染（0.7%）。切口长度1 ~ 2cm（59.5%），2 ~ 3cm（37.9%），3 ~ 4cm（1.9%），4 ~ 5cm（0.7%）。共有90名患者（59%）在转诊到我们中心之前接受了扩张、尿道内切开术、尿道成形术或多种手术。当需要任何术后内固定时，临床结局被认为是治疗失败。术后性功能障碍的患病率进行了调查，使用未经验证的questionnaire.Results：153例139（90.8%）是成功的，14（9.2%）是治疗失败。治疗失败者行尿道切开术9例，端端吻合术2例，颊粘膜移植尿道成形术1例，二期修复术2例。失败14例，12例效果满意，1例等待二期尿道成形术，1例行会阴造口术。有14例（23.3%）患者出现射精功能障碍，1例（1.6%）勃起时龟头冰冷，7例（11.6%）勃起时龟头既不饱满也不肿胀，11例（18.3%）龟头敏感性降低。结论：球部端端吻合术的成功率为90.8%。大多数患者对手术结果感到满意，尽管术后并发症，如射精功能障碍，阴茎头既不饱满也不肿胀，勃起时，或阴茎敏感性下降。
Purpose: We performed a retrospective evaluation and statistical analysis of outcome in patients who underwent bulbar end-to-end anastomosis.Materials and Methods: We reviewed 153 patients with an average age of 39 years who underwent bulbar end-to-end anastomosis between 1988 and 2006. Mean followup was 68 months. Stricture etiology was unknown (62.7%), catheter (14.4%), blunt perineal trauma (11.7%), instrumentation (9.8%), radiotherapy (0.7%) and infection (0.7%). Stricture length was 1 to 2 cm (in 59.5%), 2 to 3 cm (37.9%), 3 to 4 cm (1.9%) or 4 to 5 cm (0.7%). A total of 90 patients (59%) underwent dilation, internal urethrotomy, urethroplasty or multiple procedures before being referred to our center. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed. The prevalence of postoperative sexual dysfunction was investigated using a nonvalidated questionnaire.Results: Of 153 cases 139 (90.8%) were successful and 14 (9.2%) were treatment failures. Treatment failure was managed with urethrotomy in 9 cases, end-to-end anastomosis in 2, buccal mucosal graft urethroplasty in 1 and 2-stage repair in 2. Of 14 cases of failure 12 had a satisfactory final outcome, 1 is still waiting for the second stage of urethroplasty and 1 underwent definitive perineostomy. There were 14 patients (23.3%) who experienced ejaculatory dysfunction, 1 (1.6%) a cold glans during erection, 7 (11.6%) a glans that was neither full nor swollen during erection and 11 (18.3%) had decreased glans sensitivity. No patients complained of penile chordee or impotence.Conclusions: Bulbar end-to-end anastomosis has a success rate of 90.8%. Most patients were satisfied with the surgical outcome despite postoperative complications such as ejaculatory dysfunction, a glans that was neither full nor swollen during erection, or decreased penile sensitivity.