The Comparable Results of Minimally Invasive Therapy versus Primary Anastomosis in the Management of Partial Posterior Urethral Stricture
DOI:
https://doi.org/10.3889/oamjms.2020.3359Keywords:
posterior urethral stricture, primary anastomosis, internal urethrotomy, urethral dilation, penile perception scoresAbstract
BACKGROUND: Urinary retention has many etiologies. One of them is urethral stricture or the narrowing of urethral lumen due to fibrotic tissue. Urethral stricture is considered a medical emergency condition because it might cause complications in some extent. At present, there are several surgical techniques introduced with their advantages and disadvantages.
AIM: The study aimed to compare the outcome of minimal invasive therapy (MIT) or excision and primary anastomosis (EPA) techniques.
METHODS: A retrospective cohort study was performed on patients with partial posterior urethral stricture. The inclusion criteria were all patients with partial posterior urethral stricture who underwent MIT or EPA from 2014 to 2018. The data of International Prostate Symptom Score (IPSS), quality of life (QoL), urinary peak flow rate (Qmax), urine residue, erection hardness score, clean intermittent catheterization (CIC), recurrence, and penile perception scores (PPS) were obtained and analyzed postoperatively.
RESULTS: Thirty-four patients included in the study, consisted of 17 patients for each group. EPA group showed significantly superior to MIT in Qmax (p < 0.001), CIC (p = 0.007), and PPS score (p = 0.003). However, no significance differences were found in QoL (p = 0.071), IPSS score (p = 0.083), bladder urine residue (p = 0.688), recurrence (p = 0.225), and erectile function (p = 0.303).
CONCLUSION: EPA may be superior to MIT in some aspect. However, other advantages of MIT could be outweighed EPA techniques, such as QoL, IPSS, bladder urine residual, stricture recurrence, and erectile function. MIT still has a place to be the first-line management of partial posterior urethral stricture.
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References
Akyuz M, Sertkaya Z, Koca O, Caliskan S, Kutluhan MA, Karaman MI. Adult urethral stricture: Practice of Turkish urologists. Int Braz J Urol. 2016;42(2):339-45. https://doi. org/10.1590/s1677-5538.ibju.2014.0672 PMid:27256189
Al-Qudah HS, Santucci RA. Extended complications of urethroplasty. Int Braz J Urol. 2005;31(4):315-23. https://doi. org/10.1590/s1677-55382005000400004 PMid:16137399
Barratt RC, Bernard J, Mundy AR, Greenwell TJ. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol. 2018;7 Suppl 1:S29- 62. https://doi.org/10.21037/tau.2017.12.35 PMid:29644168
Bertrand LA, Voelzke BB, Elliott SP, Myers JB, Breyer BN, Vanni AJ, et al. Measuring and predicting patient dissatisfaction after anterior urethroplasty using patient reported outcomes measures. J Urol. 2016;196(2):453-61. https://doi.org/10.1016/j. juro.2016.01.117 PMid:26907509
Lucas ET, Koff WJ, Rosito TE, Berger M, Bortolini T, Neto BS. Assessment of satisfaction and quality of life using self-reported questionnaires after urethroplasty: A prospective analysis. Int Braz J Urol. 2017;43(2):304-10. https://doi.org/10.1590/s1677- 5538.ibju.2016.0207 PMid:28128915
Burckhardt CS, Anderson KL. The quality of life scale (QOLS): Reliability, validity, and utilization. Health Qual Life Outcomes. 2003;1:60. https://doi.org/10.1186/1477-7525-1-60. PMid:14613562
Le W, Zhou W, Li C, Wu D, Zhang J, Bian C. A preliminary clinical study of endoscopic minimally-invasive surgery in urethral stricture complicated with false passage. Springerplus. 2016;5(1):1457. https://doi.org/10.1186/s40064-016-3137-x PMid:27652033
Goel MC, Kumar M, Kapoor R. Endoscopic management of traumatic posterior urethral stricture: Early results and follow up. J Urol. 1997;157(1):95-7. https://doi.org/10.1016/ s0022-5347(01)65295-9 PMid:8976224
Hosseini J, Tabassi KT. Surgical repair of posterior urethral defects: Review of literature and presentation of experiences. Urol J. 2008;5(4):215-22. PMid:19101893
Sangkum P, Levy J, Yafi FA, Hellstrom WJ. Erectile dysfunction in urethral stricture and pelvic fracture urethral injury patients: Diagnosis, treatment, and outcomes. Andrology. 2015;3(3):443- 9. https://doi.org/10.1111/andr.12015 PMid:25784590
Gallegos M. Advances in urethral stricture management. F1000Res. 2016;5:2913. PMid:28105329
Mundy AR. Management of urethral strictures. Postgrad Med J. 2006;82(970):489-93. PMid:16891437
Tinaut-Ranera J, Arrabal-Polo MÁ, Merino-Salas S, Nogueras- Ocaña M, López-León VM, Palao-Yago F, et al. Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty. Can Urol Assoc J. 2014;8(1-2):E16-9. https://doi. org/10.5489/cuaj.1407 PMid:24454595
Gelman J, Wisenbaugh ES. Posterior urethral strictures. Adv Urol. 2015;2015:628107. https://doi.org/10.1155/2015/628107
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Copyright (c) 2020 Gede Wirya Kusuma Duarsa, Rheny Subnafeu, Anak Agung Gde Oka, I Kadek Budi Santosa, I Wayan Yudiana, Pande Made Wisnu Tirtayasa, Ida Bagus Putra Pramana, Tjokorda Gede Bagus Mahadewa, Christopher Ryalino (Author)
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