Evaluation of the effectiveness of surgical treatment of recurrent urethral stricture

Introduction. The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers. Purpose of the study. To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures. Materials and methods. At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n= 43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Q max - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients. Results. The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multistage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6±0.9 points. The average value of Qmax at the time of observation was 19.4±7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%. Conclusions. Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.

urethral stricture, recurrent urethral stricture, urethroplasty, direct visual internal urethrotomy, buccal mucosa