目的:分析因前列腺癌治疗引起的球膜尿道狭窄/狭窄(RIS)而接受吻合口尿道成形术的患者,随访长达19年,并评估患者报告的长期结局(PROMs)。在现有的研究中,缺乏包含尿道成形术特定PROM的长期随访。
方法:从2002年到2020年,确定了接受吻合口尿道成形术治疗RIS的患者。纳入标准包括完成术后4个月的膀胱镜检查和包括IPSS在内的PROM,SHIM,MSHQ-EF,6Q-LUTS,以及4个月时的全球满意度查询。此后,每年对PROM进行评估,并对PROM的不良变化或尿流/PVR参数恶化进行膀胱镜检查。PROM在术前进行了比较,术后,以及最近的后续行动。
结果:23例患者符合纳入标准。短期解剖成功率为95.7%。平均随访73.1个月(9.1-228.9),1次晚期复发,总成功率为91.3%.在排尿分数中确定了显著和持续的客观改善,生活质量,和尿道成形术特定的PROM。尽管存在性副作用,满意度为91.3%,95.7%的患者表示,在平均6年以上的随访中,他们会在知道结果的情况下再次接受手术。
结论:RIS是具有挑战性的问题,但经过精心挑选的患者可实现持久的症状缓解。应就吻合口尿道成形术后尿失禁和性副作用的风险对患有鼓膜RIS的患者进行适当咨询。然而,长期成功很高,在大多数情况下,总体QoL将有持续的主观改善。
OBJECTIVE: To analyze patients who underwent anastomotic urethroplasty for radiationinduced bulbomembranous urethral stricture/stenosis (RIS) due to prostate cancer treatment with up to 19 years of follow-up and assess long-term patient reported outcomes (PROMs). Long-term follow-up with the inclusion of urethroplasty specific PROMs is lacking in the available research.
METHODS: Patients who underwent anastomotic urethroplasty for RIS were identified from 2002 to 2020. Inclusion criteria included completion of 4-month post-operative cystoscopy and PROMs including IPSS, SHIM, MSHQ-EF, 6Q-LUTS, and global satisfaction queries at 4 months. PROMs were assessed annually thereafter, and cystoscopy was performed for adverse change in PROMs or worsening uroflow/PVR parameters. PROMs were compared at pre-op, post-op, and most recent follow-up.
RESULTS: 23 patients met inclusion criteria. Short-term anatomic success was 95.7%. At a mean follow-up of 73.1 months (9.1-228.9), one late recurrence occurred for an overall success of 91.3%. Significant and sustained objective improvement was identified in voiding scores, quality of life, and urethroplasty specific PROMs. Satisfaction was 91.3% despite sexual side effects, and 95.7% of patients stated they would have surgery again knowing their outcome at a mean of over 6 years\' follow up.
CONCLUSIONS: RIS are challenging problems, but durable symptomatic relief is achievable in well-selected patients. Patients with bulbomembranous RIS should be appropriately counseled regarding the risk of urinary incontinence and sexual side effects after anastomotic urethroplasty. However, long-term success is high, and overall QoL will have sustained subjective improvement in most cases.