[Comparative analysis of the results of treatment of patients with recurrent urethral stricture using platelet-rich plasma].

Abstract

Introduction: The treatment tactics of patients with recurrent urethral stricture requires an integrated approach. An increase in the treatment efficiency is possible not only through improvements in surgical technique, but also by influencing the pathogenetic mechanisms of the formation of urethral stricture and stimulating regeneration.

Aim: To evaluate the efficiency of reconstructive procedures using platelet-rich plasma in patients with recurrent urethral stricture.

Materials and methods: A comparative analysis of the results of surgical treatment of patients with recurrent urethral stricture with and without the use of platelet-rich plasma, who were treated at the University Clinic of Urology of Russian National Research Medical University named after N.I. Pirogov, was carried out. A total of 60 patients were included in the study. They were divided into the control (n=30) and the main group (n=30). There were no differences in length, median age, and localization of urethral stricture. The median maximum urinary flow rate preoperatively was 4.7 ml/s (1.7-11). According to etiological factors, there were 45 iatrogenic (75%), 7 traumatic (11.7%), 2 infectious strictures (3.3%) and 6 patients with hypospadias (10%).

Results: In the main group, end-to-end anastomotic urethroplasty was performed in 17, augmentation urethroplasty in 9, multi-stage urethroplasty/perineal urethrostomy in 4 cases. In the control group, end-to-end anastomotic urethroplasty was done in 24, augmentation urethroplasty in 4, multi-stage urethroplasty in 2 patients. Efficiency in the main group was 93.3%. In 2 cases, recurrence of the stricture was seen. In the control group, the efficiency was 76.7%. There were 7 recurrences. The median period of catheterization was 14 and 7 days in the control and experimental groups, respectively. The frequency of infectious complications (urethritis, epididymitis, infected wound) was 6 times lower in the main group. Median Qmax in the control group during follow-up was (min-max) 19.85 ml/sec (9-23.8), compared to 24 ml/sec (10-40) in the main group.

Conclusion: A combination of urethroplasty with a use of platelet-rich plasma improves the treatment outcomes of patients with recurrent urethral stricture. Reducing the length of bladder catheterization due to the stimulation of regeneration and the organization of the extracellular matrix allows to reduce the frequency of recurrence by 3 times. A decrease in the frequency of infectious complications also improves the results of surgical treatment, reduces the risk of recurrence and improves the quality of life of patients.