Comparative evaluation of results, frequency of complications and identification of risk factors for their development of different types of urethroplasty in patients with urethral strictures
Abstract
The observation period covered the years 2005–2024. Six observation groups were formed. The first group (N = 69) consisted of patients who underwent urethro-urethroanastomosis (UUA); the second group (N = 89) underwent buccal mucosa graft urethroplasty (BMGUP); the third group (N = 16) underwent skin flap urethroplasty (SFUP). Groups 4 and 6 were created by regrouping the main pool of patients (174). The fourth group (N = 108) included patients with Clavien-Dindo grade 0–I complications after urethroplasty; the fifth group (N = 36) had grade II–IIIa complications; and the sixth group (N = 30) had grade IIIb–IV complications. The length of the urethral stricture (SU) in group 1 was significantly shorter (2.9 ± 1.9 cm) than in groups 2 (5.9 ± 4.2 cm) and 3 (5.3 ± 3.9 cm). Accordingly, the number of SU localized in the bulbar section is significantly higher in group 1 (UUA) (82.6%) than in groups 2 (46.7%) and 3 (31.2%), and SU localized in the penile section are not represented in group 1 (UUA). But in group 3 (SFUP) SU localized in the penile section are significantly more (68.7%) than in group 2 (BMGUP) (32.2%). It is important that the SU in group 1 (UUA) are significantly simpler (6.3 ± 2.4 points) than the SU presented in group 2 (BMGUP) (8.4 ± 1.5 points) and group 3 (SFUP) (8.0 ± 1.6 points). A significantly longer (P = 0.001) postoperative bed-day was found in patients in group 1 (UUA) (17.7 ± 9.4 days), compared to patients in groups 2 (BMGUP) (10.3 ± 5.2 days) and 3 (SFUP) (11.4 ± 7.5 days). The success of BMGUP (92.1%) is statistically significantly higher compared to those performed by UUA (79.7%) and SFUP (75.0%) (χ2 = 6.5, df = 2, P = 0.023 for group 1 vs. 2; P = 0.039 for group 2 vs. 3). A prognostic assessment of clinical parameters of patients without and with early or late postoperative complications was also performed in order to identify probable risk factors for their development. The following risk factors were significant: localization (of stricture prostatic and penile urethra), type of urethroplasty (BMGUP), patient age, disease duration. According to the calculations, when SU is localized in the prostatic urethra, the risk of Clavien-Dindo grade IIIb–IV complications increases by 5.89 and in the penile urethra, the risk of Clavien IIIb-IV complications decreases by 72%. When performing BMGUP, the risk of Clavien IIIb-IV complications decreases by 58% and 75% compared to Clavien class 0-I and II-IIIa complications, respectively. The age of patients under 45 years reduces the risk of Clavien class IIIb-IV complications by 78%, and over 45 years increases the risk by 4.48 times. The duration of the disease for more than 7 years increases the risk of developing complications of class IIIb-IV according to Clavien by 4.16 times, and the duration of less than 7 years reduces the risk of developing this class of complications by 76%.
Keywords: Buccal mucosa graft urethroplasty, skin flap urethroplasty, urethra, risk factors