Ventral Oral Mucosal Onlay Graft Urethroplasty in Nontraumatic Bulbar Urethral Strictures: Surgical Technique and Multivariable Analysis of Results in 214 Patients
Ventral Oral Mucosal Onlay Graft Urethroplasty in Nontraumatic Bulbar Urethral Strictures: Surgical Technique and Multivariable Analysis of Results in 214 Patients
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DOI：
10.1016/j.eururo.2013.05.046
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发表时间：
2013-09-01
期刊：
影响因子：
23.4
通讯作者：
Lazzeri, Massimo
中科院分区：
文献类型：
--
作者：
Barbagli, Guido;Montorsi, Francesco;Lazzeri, Massimo
背景：建议在近端球部狭窄中使用腹侧口腔粘膜嵌体移植物，其中厚的海绵体为移植物提供了良好的支撑。该技术中使用的一些技术步骤目前在文献中存在争议。目的：描述这种尿道成形术的手术步骤，并使用多变量逻辑回归分析研究成功的预测因素。设计、设置和参与者：这是一项描述性观察性回顾性研究，对象为 1999 年 5 月至 2010 年 11 月期间在单个大容量中心因尿道球部狭窄接受尿道成形术的 214 名患者。研究纳入标准为非外伤性尿道球部狭窄，长度范围为 1.3 厘米至 6.8 厘米。排除标准是外伤性狭窄、全尿道狭窄、硬化性苔藓和尿道下裂修复失败。手术过程：将口腔移植物放置在尿道球部腹侧表面，并使用专用器械和手术技术将口腔移植物尽可能推向近端。结果测量和统计分析：主要结果测量是客观结果，定义为随访时没有狭窄复发。当术后需要任何器械时，客观结果被认为是失败的。开发了多变量逻辑回归分析。所有测试均为两侧，显着性水平设置为 0.05。结果和局限性：中位随访时间为 54 个月。在 214 名患者中，183 名（85.5%）成功，31 名（14.5%）失败。术前最大流量 (Q(max)) 是手术结果的重要预测因素（比值比：1.352；p = 0.001）。年龄、长度和狭窄类型以及既往治疗并不是手术结果的显着预测因素（所有 p > 0.05）。我们调查的局限性是缺乏主观评估或使用特定工具，例如问卷。结论：腹侧口移植尿道成形术是非创伤性球部狭窄的有效选择。术前 Q(max) 可预测尿道成形术失败。 (C) 2013 年欧洲泌尿外科协会。由 Elsevier B.V 出版。保留所有权利。
Background: The ventral oral mucosal onlay graft is suggested in proximal bulbar strictures where the thick spongiosum provides excellent support to the graft. Some technical steps used in this technique are currently under debate in the literature.Objective: To describe the surgical steps of this urethroplasty and investigate predictive factors of success using a multivariable logistic regression analysis.Design, setting, and participants: This is a descriptive observational retrospective study of 214 patients who underwent urethroplasty for bulbar urethral strictures between May 1999 and November 2010 in a single high-volume center. Study inclusion criteria were patients presenting nontraumatic bulbar urethral strictures ranging from 1.3 cm to 6.8 cm in length. Exclusion criteria were traumatic strictures, panurethral strictures, lichen sclerosus, and failed hypospadias repair.Surgical procedure: The oral graft was placed on the ventral bulbar urethral surface and pushed as proximally as possible using dedicated instruments and surgical techniques.Outcome measurements and statistical analysis: The primary outcome measure was the objective result, defined as the absence of stricture recurrence at follow-up. The objective outcome was considered a failure when any postoperative instrumentation was needed. Multivariable logistic regression analysis was developed. All tests were two sided with a significance level set at 0.05.Results and limitations: Median follow-up was 54 mo. Of the 214 patients, 183 (85.5%) were successful and 31 (14.5%) were failures. The preoperative maximum flow rate (Q(max)) was a significant predictor of surgical outcome (odds ratio: 1.352; p = 0.001). Age, length, and type of stenosis, and previous treatment were not significant predictors of surgical outcome (all p > 0.05). The limitation of our survey is the absence of a subjective evaluation or the use of specific tools, such as a questionnaire.Conclusions: Ventral oral graft urethroplasty represents a valid option in nontraumatic bulbar strictures. Preoperative Q(max) may be predictive of urethroplasty failure. (C) 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.