Abstract：
BACKGROUND: Urethral strictures, particularly those refractory to endoscopic interventions, are commonly treated through open urethroplasty. However, predicting recurrence in homogeneous patient populations remains challenging.
METHODS: To address this, we developed an intraoperative urethral stricture assessment tool aiming to identify comprehensive risk predictors. The assessment includes detailed parameters on stricture location, length, urethral bed width, spongiosum thickness, obliteration grade, and spongiofibrosis extension. The tool was prospectively implemented in 106 men with anterior one-stage augmentation urethroplasty from April 2020 to October 2021.
RESULTS: An intraoperative granular assessment of intricate stricture characteristics is feasible. Comparative analyses revealed significant differences between bulbar and penile strictures. Bulbar strictures exhibited wider urethral beds and thicker spongiosum compared to penile strictures (all p < 0.001). The assessment showed marked variations in the degree of obliteration and spongiofibrosis extension.
CONCLUSIONS: Our tool aligns with efforts to standardize urethral surgery, providing insights into subtle disease intricacies and enabling comparisons between institutions. Notably, intraoperative assessment may surpass the limitations of preoperative imaging, emphasizing the necessity of intraoperative evaluation. While limitations include a single-institution study and limited sample size, future research aims to refine this tool and determine its impact on treatment strategies, potentially improving long-term outcomes for urethral strictures.
METHODS: To address this, we developed an intraoperative urethral stricture assessment tool aiming to identify comprehensive risk predictors. The assessment includes detailed parameters on stricture location, length, urethral bed width, spongiosum thickness, obliteration grade, and spongiofibrosis extension. The tool was prospectively implemented in 106 men with anterior one-stage augmentation urethroplasty from April 2020 to October 2021.
RESULTS: An intraoperative granular assessment of intricate stricture characteristics is feasible. Comparative analyses revealed significant differences between bulbar and penile strictures. Bulbar strictures exhibited wider urethral beds and thicker spongiosum compared to penile strictures (all p < 0.001). The assessment showed marked variations in the degree of obliteration and spongiofibrosis extension.
CONCLUSIONS: Our tool aligns with efforts to standardize urethral surgery, providing insights into subtle disease intricacies and enabling comparisons between institutions. Notably, intraoperative assessment may surpass the limitations of preoperative imaging, emphasizing the necessity of intraoperative evaluation. While limitations include a single-institution study and limited sample size, future research aims to refine this tool and determine its impact on treatment strategies, potentially improving long-term outcomes for urethral strictures.
摘要：
背景：尿道狭窄，特别是那些难以进行内窥镜干预的，通常通过开放式尿道成形术治疗。然而,预测同质患者群体的复发仍然具有挑战性.
方法：要解决这个问题，我们开发了一种术中尿道狭窄评估工具，旨在确定综合风险预测因子。评估包括狭窄位置的详细参数，长度,尿道床宽度,海绵体厚度,闭塞等级，和海绵状纤维化扩展。该工具在2020年4月至2021年10月的106名男性中前瞻性地实施了一期前尿道成形术。
结果：术中颗粒评估复杂的狭窄特征是可行的。比较分析显示，延髓和阴茎狭窄之间存在显着差异。与阴茎狭窄相比，球囊狭窄表现出更宽的尿道床和更厚的海绵体（所有P<0.001）。评估显示闭塞程度和海绵状纤维化扩展的显着变化。
结论：我们的工具与标准化尿道手术的努力相一致，提供对微妙的疾病复杂性的见解，并使机构之间的比较。值得注意的是,术中评估可能会超过术前影像学的局限性，强调术中评估的必要性。虽然限制包括单一机构研究和有限的样本量，未来的研究旨在完善这一工具，并确定其对治疗策略的影响，可能改善尿道狭窄的长期结局。
方法：要解决这个问题，我们开发了一种术中尿道狭窄评估工具，旨在确定综合风险预测因子。评估包括狭窄位置的详细参数，长度,尿道床宽度,海绵体厚度,闭塞等级，和海绵状纤维化扩展。该工具在2020年4月至2021年10月的106名男性中前瞻性地实施了一期前尿道成形术。
结果：术中颗粒评估复杂的狭窄特征是可行的。比较分析显示，延髓和阴茎狭窄之间存在显着差异。与阴茎狭窄相比，球囊狭窄表现出更宽的尿道床和更厚的海绵体（所有P<0.001）。评估显示闭塞程度和海绵状纤维化扩展的显着变化。
结论：我们的工具与标准化尿道手术的努力相一致，提供对微妙的疾病复杂性的见解，并使机构之间的比较。值得注意的是,术中评估可能会超过术前影像学的局限性，强调术中评估的必要性。虽然限制包括单一机构研究和有限的样本量，未来的研究旨在完善这一工具，并确定其对治疗策略的影响，可能改善尿道狭窄的长期结局。
