Surgical and patient-reported outcomes of urethroplasty for bulbar stricture due to a straddle injury
Surgical and patient-reported outcomes of urethroplasty for bulbar stricture due to a straddle injury
复制标题
跨骑损伤导致球部狭窄的尿道成形术的手术结果和患者报告的结果
作者：
A. Horiguchi;M. Shinchi;K. Ojima;Yuichi Arai;Mina Hatanaka;K. Ito;T. Asano;Eiji Takahashi;F. Kimura;R. Azuma
目的根据手术和患者报告的结果，报告我们在治疗跨骑损伤后球囊狭窄的尿道成形术中的经验。方法回顾性分析2010年至2018年因跨坐式损伤行球囊狭窄尿道成形术的患者（N = 132）。成功的尿道成形术被定义为不需要额外的治疗。患者在尿道成形术前（基线）和术后1年完成经验证的尿道狭窄手术患者报告结果测量和男性性健康调查问卷（SHIM）。结果患者年龄中位数（四分位数间距）为50岁（36 ~ 62岁）；尿道造影估计尿道狭窄长度8.6 (5.1-12.5)mm；术后随访41（22-56）个月。95.5% （n = 126）的患者行尿道吻合术，4.5% （n = 6）的患者行颊粘膜移植术。尿道成形术成功率98.5% （n = 130）。2例因尿道周围脓肿而失败的患者均经尿道成形术成功抢救。84例患者（63.6%）在术后1年完成问卷调查。平均下尿路（LUT）特异性生活质量、SHIM和euroqol -视觉模拟量表得分均从基线时的2.6、8.5和57.5显著提高到术后的0.3、11.6和84.6 （p < 0.0001, p = 0.004, p < 0.0001）。所有患者满意（19/84,22.6%）或非常满意（65/84,77.3%）。较低的术后LUT症状评分是“非常满意”患者的独立预测因子（优势比0.81,95%可信区间0.67-0.98,p = 0.002）。结论尿道成形术治疗跨骑损伤后球囊狭窄成功率高，对主客观症状均有利。
Purpose To report our experience with urethroplasty for bulbar stricture due to a straddle injury based on surgical and patient-reported outcomes. Methods Patients who underwent urethroplasty for bulbar stricture due to a straddle injury between 2010 and 2018 were retrospectively analyzed ( N = 132). Successful urethroplasty was defined as the absence of the need for additional treatment. The patients completed the validated Urethral Stricture Surgery Patient-reported Outcome Measure and Sexual Health Inventory for Men (SHIM) questionnaires before (baseline) and 1 year after urethroplasty. Results The median (interquartile range) age was 50 (36–62) years; urethral stricture length estimated from urethrograms, 8.6 (5.1–12.5) mm; and postoperative follow-up, 41 (22–56) months. Urethroplasty was performed through excision with primary anastomosis in 95.5% ( n = 126) and onlay augmentation with a buccal mucosa graft in 4.5% ( n = 6). Urethroplasty was successful in 98.5% ( n = 130). The 2 failures due to periurethral abscess were successfully salvaged with another urethroplasty. Eighty-four patients (63.6%) completed the questionnaires at 1 year postoperatively. The mean lower urinary tract (LUT)-specific quality of life, SHIM, and EuroQol-visual analog scale scores all improved significantly from 2.6, 8.5, and 57.5 at baseline to 0.3, 11.6, and 84.6 postoperatively ( p < 0.0001, p = 0.004, p < 0.0001, respectively). All patients were either “satisfied” (19/84, 22.6%) or “very satisfied” (65/84, 77.3%). Lower postoperative LUT symptom score was an independent predictor of a “very satisfied” patient (odds ratio 0.81, 95% confidence interval 0.67–0.98, p = 0.002). Conclusions Urethroplasty for bulbar stricture due to a straddle injury has a high success rate and is beneficial for both subjective and objective symptoms.