Results of treatment and risk factors for recurrence of iatrogenic urethral strictures in men
- Authors: Zhivov A.V1,2,3, Tedeev R.L1,2, Koshmelev A.A1,4, Karpovich A.V4, Yudovskyi S.O4, Pushkar D.Y.1
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Affiliations:
- A.I. Evdokimov Moscow State University of Medicine and Dentistry
- AO “Ilyin hospital”
- ZAO «European Medical Center
- Municipal clinical hospital named after S.I. Spasokukotskiy
- Issue: No 5 (2019)
- Pages: 7-13
- Section: Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/312277
- DOI: https://doi.org/10.18565/urology.2019.5.7-13
- ID: 312277
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Abstract
Aim. Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. Materials and methods. A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. Results. Average stricture length was 5,8±4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length >5,5 cm. Conclusion. Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods ofthe US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.
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About the authors
A. V Zhivov
A.I. Evdokimov Moscow State University of Medicine and Dentistry; AO “Ilyin hospital”; ZAO «European Medical Center
Email: a.zhivov@ihospital.ru
Ph.D., Chief, Head of the Center of Reconstructive urology
R. L Tedeev
A.I. Evdokimov Moscow State University of Medicine and Dentistry; AO “Ilyin hospital”
Email: rtedeev@emcmos.ru
A. A Koshmelev
A.I. Evdokimov Moscow State University of Medicine and Dentistry; Municipal clinical hospital named after S.I. Spasokukotskiy
Email: a.koshmelev@ihospital.ru
A. V Karpovich
Municipal clinical hospital named after S.I. Spasokukotskiy; Municipal clinical hospital named after S.I. Spasokukotskiy
Email: olkarpovich@yandex.ru
S. O Yudovskyi
Municipal clinical hospital named after S.I. Spasokukotskiy
Email: yudovskys@gmail.com
D. Yu Pushkar
A.I. Evdokimov Moscow State University of Medicine and Dentistry
Email: pushkardm@mail.ru
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