Management and outcomes of urethral stricture: single centre experience over 13 years

Abstract

Aim: To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years.

Materials and methods: Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account.

Results: Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique.

Conclusion: Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.

Zusammenfassung

Zweck: Präsentation einer umfassenden Zusammenfassung von Diagnose, Behandlung und Nachsorge von Patienten, die sich in den letzten 13 Jahren einer offenen Urethroplastik in unserem tertiären Überweisungszentrum zur Behandlung von Harnröhrenstrikturen unterzogen haben.

Material und Methoden: 245 Patienten, die sich zwischen Januar 2008 und Juni 2021 einer offenen Urethroplastik unterzogen, wurden retrospektiv analysiert. Detaillierte Anamnese, körperliche Untersuchung, Uroflowmetrie, retrograde Urethrographie und/oder Miktionszystourethrographie und/oder Urethroskopie wurden während des gesamten präoperativen Diagnoseprozesses verwendet. Bei der Bewertung der postoperativen Offenheitsraten wurden das Fehlen präoperativer Miktionssymptome nach der Operation und Qmax 15 ml/s und mehr berücksichtigt.

Ergebnisse: Die mittlere Strikturlänge betrug 3,8 +/- 1,4 cm. Transurethrale endoskopische Eingriffe bei 79 Patienten (32,2 %), Katheterisierung bei 55 Patienten (22,4 %), Traumata bei 54 Patienten (22 %), Infektionen bei 15 Patienten (6,2 %) und idiopathische bei 42 Patienten (17,2 %) waren die Ursachen für die Striktur. Wangenschleimhauttransplantat wurde bei 125 Patienten (51 %) verwendet, Penishautlappen bei 32 Patienten (13 %), End-zu-End-Anastomose bei 83 Patienten (33,8 %) und Heineke-Mikulicz-Technik bei 5 Patienten (2 %). Die mittlere Nachbeobachtungszeit betrug 67,1 +/- 28,9 Monate. Die Erfolgsraten der Patienten waren 84 % (105) bei Wangenschleimhauttransplantation, 78,1 % (25) bei Penishautlappen, 86,7 % (72) bei End-zu-End-Anastomose und 80 % (4) bei Heineke-Mikulicz-Technik.

Schlussfolgerung: Unter den Behandlungsoptionen der Harnröhrenstriktur stehen die Techniken der Urethroplastik als Behandlungserfolg an erster Stelle. Durch die Berücksichtigung der Faktoren, die zur Bildung der Striktur führen, durch die Bemerkung der intraoperativen Befunde und der chirurgischen Erfahrung wird der Nutzen für den Patienten maximiert.

Keywords

Urethra - Stricture - Treatment - Urethroplasty

Schlüsselwörter

Harnröhre - Striktur - Behandlung - Urethroplastik

Publication History

Received: 05 June 2022

Accepted after revision: 16 July 2022

Article published online:
24 August 2022

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