尿道远端狭窄疾病的外科治疗。

Q3 Medicine 北京大学学报(医学版) Pub Date : 2024-12-18
Jie Wang, Jianwei Wang, Haizhui Xia, Xiao Xu, Jianpo Zhai, Feng He, Guanglin Huang, Guizhong Li
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There were also 26 instances where strictures involved both the navicular fossa and meatus; one case underwent PSFU while 25 underwent OMGU. Based on different surgical methods used for treatment purposes we divided the patients into MO group, PSFU group and OMGU group. The age of the three groups was (48.8±20.0) years, (53.3±21.8) years and (44.5±16.4) years. The mean±SD body mass index (BMI) was (28.6±3.9) kg/m<sup>2</sup>, (29.6±3.2) kg/m<sup>2</sup> and (29.2±4.8) kg/m<sup>2</sup>. The preoperative maximum flow rate was (5.8±2.3) mL/s, (6.8±2.4) mL/s and (5.7±3.1) mL/s.</p><p><strong>Results: </strong>All the operations were successfully completed without Clavien Ⅲ or Ⅳ complications. The median length of strictures (measured intraoperatively) in the three groups were 1.1 (1.0, 1.6), 1.5 (1.1, 2.0) and 4.0 (2.5, 5.0) cm. The median operation time was 60.0 (60.0, 75.0), 85.0 (75.0, 112.5) and 180.0 (75.0, 330.0) min. The median estimated blood loss was 5.0 (2.0, 10.0), 15.0 (5.0, 42.5) and 180.0 (135.0, 216.3) mL. The median postoperative hospital stay was 3.5 (2.0, 5.0), 6.5 (3.5, 7.0) and 7.5 (7.0, 11.3) days. The median follow-up duration was 40.0 (26.3, 57.3), 55.0 (18.8, 62.8) and 52.5 (30.5, 64.0) months. The median postoperative maximum flow rate was 18.3 (15.5, 19.8), 19.2 (16.1, 20.1) and 17.2 (14.2, 19.6) mL/s. Among the 38 patients with MO, 33 cases had normal urination without reintervention, and 5 cases experienced recurrent strictures and required regular urethral dilation. Among the 8 patients with PSFU, 7 cases had normal urination without reintervention, and one case developed a urinary fistula, for which intervention was recommended but the patient opted to maintain the status quo. Among the 34 patients with OMGU, 28 cases had normal urination without reintervention. There were 6 instances of stenosis recurrence, with 5 cases requiring regular urethral dilations and one case requiring reconstructive surgery. The overall success rate of operation was 85.0%, and the reintervention rate was 15.0%. Statistical analysis revealed significant differences in etiologies among the three groups (<i>P</i>=0.002), as well as in stricture locations (<i>P</i> < 0.001), length of strictures (<i>P</i> < 0.001), operation time (<i>P</i> < 0.001), estimated blood loss (<i>P</i> < 0.001) and postoperative hospital stays (<i>P</i> < 0.001). However, no significant differences were observed in terms of age, BMI, history of previous urethral stricture surgeries, preoperative maximum flow rate, follow-up duration, postoperative maximum flow rate and reintervention rate. Univariate and multivariate Logistic regression analyses indicated that a history of previous urethral stricture surgeries was a risk factor for postoperative reintervention (<i>P</i>=0.026).</p><p><strong>Conclusion: </strong>MO and PSFU are primarily suitable for treating short-segment (≤1.5 cm) distal penile urethral strictures, whereas OMGU is more appropriate for longer segment strictures. MO and OMGU can both be utilized in managing MGLS cases. PSFU and OMGU are more conducive to improving the appearance of the urethral meatus. 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引用次数: 0

摘要

目的:探讨尿道远端狭窄的手术治疗方法。方法:回顾性收集2018年1月~ 2022年12月首都医科大学附属北京积水潭医院收治的80例尿道远端狭窄患者的临床资料。其中男性生殖器硬化地衣(MGLS) 33例,医源性损伤25例,术后尿道下裂12例,外伤等其他原因10例。54例狭窄累及尿道道,其中38例行切开尿道(MO), 7例行阴茎皮瓣尿道成形术(PSFU), 9例行口腔黏膜移植尿道成形术(OMGU)。还有26例狭窄涉及舟状窝和椎道;1例行PSFU, 25例行OMGU。根据手术方式的不同,我们将患者分为MO组、PSFU组和OMGU组。三组患者年龄分别为(48.8±20.0)岁、(53.3±21.8)岁和(44.5±16.4)岁。平均±SD体重指数(BMI)分别为(28.6±3.9)kg/m2、(29.6±3.2)kg/m2和(29.2±4.8)kg/m2。术前最大流速分别为(5.8±2.3)mL/s、(6.8±2.4)mL/s和(5.7±3.1)mL/s。结果:所有手术均顺利完成,无ClavienⅢ或Ⅳ并发症。三组狭窄的中位长度(术中测量)分别为1.1(1.0、1.6)、1.5(1.1、2.0)和4.0(2.5、5.0)cm。手术时间中位数分别为60.0(60.0,75.0)、85.0(75.0,112.5)和180.0 (75.0,330.0)min。估计失血量中位数分别为5.0(2.0,10.0)、15.0(5.0,42.5)和180.0 (135.0,216.3)mL。术后住院时间中位数分别为3.5(2.0,5.0)、6.5(3.5,7.0)和7.5 (7.0,11.3)d。中位随访时间分别为40.0(26.3,57.3)、55.0(18.8,62.8)和52.5(30.5,64.0)个月。术后最大流量中位数分别为18.3(15.5,19.8)、19.2(16.1,20.1)和17.2 (14.2,19.6)mL/s。38例MO患者中,33例排尿正常,无再干预,5例复发性狭窄,需定期扩张尿道。8例PSFU患者中,7例排尿正常,未进行再干预,1例出现尿瘘,建议进行干预,但患者选择维持现状。34例OMGU患者中,28例排尿正常,无再干预。尿道狭窄复发6例,其中5例需要定期尿道扩张,1例需要行尿道重建手术。手术总成功率85.0%,再干预率15.0%。统计分析显示,三组患者的病因、狭窄部位(P < 0.001)、狭窄长度(P < 0.001)、手术时间(P < 0.001)、估计失血量(P < 0.001)和术后住院时间(P < 0.001)差异均有统计学意义(P=0.002)。年龄、BMI、既往尿道狭窄手术史、术前最大流量、随访时间、术后最大流量、再干预率差异无统计学意义。单因素和多因素Logistic回归分析显示,既往尿道狭窄手术史是术后再干预的危险因素(P=0.026)。结论:MO和PSFU主要适用于短节段(≤1.5 cm)阴茎远端尿道狭窄,OMGU更适用于长节段狭窄。MO和OMGU都可用于管理MGLS病例。PSFU和OMGU更有利于改善尿道道外观。阴茎远端尿道狭窄手术治疗成功率为85.0%,15.0%患者术后仍需手术干预,既往尿道狭窄手术史是术后再干预的危险因素。
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[Surgical management of the distal urethral stricture diseases].

Objective: To evaluate the surgical methods for treating distal urethral stricture.

Methods: The clinical data of 80 patients with distal urethral stricture in Beijing Jishuitan Hospital, Captial Medical University between January 2018 and December 2022 were retrospectively collected. Including male genital lichen sclerosus (MGLS) 33 cases, iatrogenic injury 25 cases, postoperative hypospadias 12 cases, and other causes such as trauma 10 cases. Among these cases, strictures involved the urethral meatus in 54 instances, of which 38 were treated with meatotomy (MO), 7 with penile skin flap urethroplasty (PSFU), and 9 with oral mucosa graft urethroplasty (OMGU). There were also 26 instances where strictures involved both the navicular fossa and meatus; one case underwent PSFU while 25 underwent OMGU. Based on different surgical methods used for treatment purposes we divided the patients into MO group, PSFU group and OMGU group. The age of the three groups was (48.8±20.0) years, (53.3±21.8) years and (44.5±16.4) years. The mean±SD body mass index (BMI) was (28.6±3.9) kg/m2, (29.6±3.2) kg/m2 and (29.2±4.8) kg/m2. The preoperative maximum flow rate was (5.8±2.3) mL/s, (6.8±2.4) mL/s and (5.7±3.1) mL/s.

Results: All the operations were successfully completed without Clavien Ⅲ or Ⅳ complications. The median length of strictures (measured intraoperatively) in the three groups were 1.1 (1.0, 1.6), 1.5 (1.1, 2.0) and 4.0 (2.5, 5.0) cm. The median operation time was 60.0 (60.0, 75.0), 85.0 (75.0, 112.5) and 180.0 (75.0, 330.0) min. The median estimated blood loss was 5.0 (2.0, 10.0), 15.0 (5.0, 42.5) and 180.0 (135.0, 216.3) mL. The median postoperative hospital stay was 3.5 (2.0, 5.0), 6.5 (3.5, 7.0) and 7.5 (7.0, 11.3) days. The median follow-up duration was 40.0 (26.3, 57.3), 55.0 (18.8, 62.8) and 52.5 (30.5, 64.0) months. The median postoperative maximum flow rate was 18.3 (15.5, 19.8), 19.2 (16.1, 20.1) and 17.2 (14.2, 19.6) mL/s. Among the 38 patients with MO, 33 cases had normal urination without reintervention, and 5 cases experienced recurrent strictures and required regular urethral dilation. Among the 8 patients with PSFU, 7 cases had normal urination without reintervention, and one case developed a urinary fistula, for which intervention was recommended but the patient opted to maintain the status quo. Among the 34 patients with OMGU, 28 cases had normal urination without reintervention. There were 6 instances of stenosis recurrence, with 5 cases requiring regular urethral dilations and one case requiring reconstructive surgery. The overall success rate of operation was 85.0%, and the reintervention rate was 15.0%. Statistical analysis revealed significant differences in etiologies among the three groups (P=0.002), as well as in stricture locations (P < 0.001), length of strictures (P < 0.001), operation time (P < 0.001), estimated blood loss (P < 0.001) and postoperative hospital stays (P < 0.001). However, no significant differences were observed in terms of age, BMI, history of previous urethral stricture surgeries, preoperative maximum flow rate, follow-up duration, postoperative maximum flow rate and reintervention rate. Univariate and multivariate Logistic regression analyses indicated that a history of previous urethral stricture surgeries was a risk factor for postoperative reintervention (P=0.026).

Conclusion: MO and PSFU are primarily suitable for treating short-segment (≤1.5 cm) distal penile urethral strictures, whereas OMGU is more appropriate for longer segment strictures. MO and OMGU can both be utilized in managing MGLS cases. PSFU and OMGU are more conducive to improving the appearance of the urethral meatus. The success rate of surgical management of distal penile urethral stricture is 85.0%, 15.0% of the patients still require surgical intervention after surgery, and having history of previous urethral stricture surgeries is a risk factor for postoperative reintervention.

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来源期刊
北京大学学报(医学版)
北京大学学报(医学版) Medicine-Medicine (all)
CiteScore
0.80
自引率
0.00%
发文量
9815
期刊介绍: Beijing Da Xue Xue Bao Yi Xue Ban / Journal of Peking University (Health Sciences), established in 1959, is a national academic journal sponsored by Peking University, and its former name is Journal of Beijing Medical University. The coverage of the Journal includes basic medical sciences, clinical medicine, oral medicine, surgery, public health and epidemiology, pharmacology and pharmacy. Over the last few years, the Journal has published articles and reports covering major topics in the different special issues (e.g. research on disease genome, theory of drug withdrawal, mechanism and prevention of cardiovascular and cerebrovascular diseases, stomatology, orthopaedic, public health, urology and reproductive medicine). All the topics involve latest advances in medical sciences, hot topics in specific specialties, and prevention and treatment of major diseases. The Journal has been indexed and abstracted by PubMed Central (PMC), MEDLINE/PubMed, EBSCO, Embase, Scopus, Chemical Abstracts (CA), Western Pacific Region Index Medicus (WPR), JSTChina, and almost all the Chinese sciences and technical index systems, including Chinese Science and Technology Paper Citation Database (CSTPCD), Chinese Science Citation Database (CSCD), China BioMedical Bibliographic Database (CBM), CMCI, Chinese Biological Abstracts, China National Academic Magazine Data-Base (CNKI), Wanfang Data (ChinaInfo), etc.
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