Purpose: We investigated the success rate of different surgical techniques for bulbar stricture repair. Methods: Retrospective study of patients with bulbar urethral strictures treated using different techniques. The primary outcome of the study was to evaluate the overall results of treatment (success vs. failure); the secondary outcome was to evaluate the outcome according to any surgical technique. Cysto-urethrography was performed 1 month following surgery. Patients underwent clinical evaluation, uroflowmetry and residual urine measurement every 6 months for 2 years after surgery and later once on year. When patient showed obstructive symptoms, Qmax < 12 ml/s, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as failures. A bivariable and multivariable statistical analysis was performed. Results: Overall, 1242 patients were included in the study with mean age 40 years (range 12–84). Median stricture length was 4 cm (range 1–8). The median follow-up was 103 months (range 12–362). Over 1242 patients, 916 (73.8%) were success and 326 (26.2%) failures. Fourteen different surgical techniques showed a success rate ranging from 87.5 to 14.3%. The multivariable analysis showed that stricture length was an independent predictor factors for failure: p < 0.0001 CI 1146–1509. End–end anastomosis and oral mucosa graft urethroplasty are independent predictor factor of success after internal urethrotomy failure. Conclusions: Our results showed that treatment of bulbar urethral stricture is satisfactory on 73.8% of patients, but with a wide range of success rate (from 14.3 to 87.5%) using different techniques. Oral mucosa is greatly superior to the skin as substitute material.

Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results

Loreto C.;
2019

Abstract

Purpose: We investigated the success rate of different surgical techniques for bulbar stricture repair. Methods: Retrospective study of patients with bulbar urethral strictures treated using different techniques. The primary outcome of the study was to evaluate the overall results of treatment (success vs. failure); the secondary outcome was to evaluate the outcome according to any surgical technique. Cysto-urethrography was performed 1 month following surgery. Patients underwent clinical evaluation, uroflowmetry and residual urine measurement every 6 months for 2 years after surgery and later once on year. When patient showed obstructive symptoms, Qmax < 12 ml/s, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as failures. A bivariable and multivariable statistical analysis was performed. Results: Overall, 1242 patients were included in the study with mean age 40 years (range 12–84). Median stricture length was 4 cm (range 1–8). The median follow-up was 103 months (range 12–362). Over 1242 patients, 916 (73.8%) were success and 326 (26.2%) failures. Fourteen different surgical techniques showed a success rate ranging from 87.5 to 14.3%. The multivariable analysis showed that stricture length was an independent predictor factors for failure: p < 0.0001 CI 1146–1509. End–end anastomosis and oral mucosa graft urethroplasty are independent predictor factor of success after internal urethrotomy failure. Conclusions: Our results showed that treatment of bulbar urethral stricture is satisfactory on 73.8% of patients, but with a wide range of success rate (from 14.3 to 87.5%) using different techniques. Oral mucosa is greatly superior to the skin as substitute material.
Long-term results; Oral mucosa; Skin graft; Surgical technique; Urethra; Urethroplasty; Urethrotomy; Adolescent; Adult; Aged; Aged, 80 and over; Child; Humans; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Treatment Outcome; Urethral Stricture; Urologic Surgical Procedures, Male; Young Adult
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/376842
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