Email this article Multi-stage surgery for anterior urethral strictures: assessment of immediate and long-term surgical outcomes
- Authors: Kogan M.I.1, Glukhov V.P.1, Ilyash A.V.1, Mitusov V.V.1, Vasilyev O.N.1
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Affiliations:
- Rostov State Medical University
- Issue: Vol 12, No 4 (2022)
- Pages: 277-286
- Section: Original articles
- URL: https://journals.rcsi.science/uroved/article/view/134230
- DOI: https://doi.org/10.17816/uroved115220
- ID: 134230
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Abstract
BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations.
AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures.
MATERIALS AND METHODS: The study included 110 men aged 18–84 years who underwent multi-stage urethroplasty for the anterior urethral structures in 2010–2019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months.
RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases.
CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.
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##article.viewOnOriginalSite##About the authors
Mikhail I. Kogan
Rostov State Medical University
Email: dept_kogan@mail.ru
ORCID iD: 0000-0002-1710-0169
SPIN-code: 6300-3241
Scopus Author ID: 7102617447
ResearcherId: R-8596-2017
Dr. Sci. (Med.), Professor, Honored Scientist of the Russian Federation, Head of the Department of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course)
Russian Federation, Rostov-on-DonVladimir P. Glukhov
Rostov State Medical University
Author for correspondence.
Email: docc.gvp@yandex.ru
ORCID iD: 0000-0002-8486-9357
SPIN-code: 5702-6243
Scopus Author ID: 7005476242
ResearcherId: S-8462-2017
Cand. Sci. (Med.), Associate Professor of the Department of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Сourse)
Russian Federation, Rostov-on-DonAnna V. Ilyash
Rostov State Medical University
Email: annailyash@yandex.ru
ORCID iD: 0000-0001-8433-8567
SPIN-code: 2327-3900
Scopus Author ID: 57202621468
ResearcherId: R-9793-2017
Cand. Sci. (Med.), Assistant of the Department of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Сourse)
Russian Federation, Rostov-on-DonValeriy V. Mitusov
Rostov State Medical University
Email: mvv55@list.ru
ORCID iD: 0000-0001-7706-8925
SPIN-code: 6666-2648
Scopus Author ID: 6505987316
ResearcherId: T-3422-2017
Dr. Sci. (Med.), Professor of the Department of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Course)
Russian Federation, Rostov-on-DonOleg N. Vasilyev
Rostov State Medical University
Email: vasilyev_on@mail.ru
ORCID iD: 0000-0001-5642-4521
SPIN-code: 8565-4276
Scopus Author ID: 57192809448
Dr. Sci. (Med.), Associate Professor of the Department of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Сourse), Head of the Urological Division of the Clinic
Russian Federation, Rostov-on-DonReferences
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