Perineal and penile urethrostomy: surgical outcome and risk assessment of complications


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Abstract

Introduction. Urethral repair in the complex urethral strictures (US) is associated with a high risk of failure. In some cases, urethrostomy is justified when choosing a method of treatment for this category of patients. Purpose of the study. To assess the results of perineal and penile urethrostomy and identify factors associated with the development of early surgical complications and urethrostomy stenosis (USs). Materials and methods. 85 patients aged 53.9 years underwent urethrostomy from 2010 to 2019: permanent - 48 (56.5%), due to refusal of urethroplasty - 37 (43.5%). Penile urethrostomy was formed in 41 (48.2%) patients, perineal USs - in 44 (51.8%), respectively. The US etiology was as follows: inflammatory - 32.9%, iatrogenic - 29.4%, idiopathic - 28.2%, traumatic - 9.4%. The US length was 6 cm or more in 58.8% patients, multifocal lesions occurred in 22.4% cases, subtotal - in 28.2%. The criterion for successful treatment was the absence of complications requiring repeated surgery on the urethra and / or systemic bougienage (median follow-up - 58 mo). The contribution of various factors to the increased risk of developing USs was assessed using univariate analysis by calculating the odds-ratio (OR, 95% CI). Statistical significance was tested using the x2 test, Fisher’s test. Multivariate analysis was performed using logistic regression. Results. Early postoperative complications (EPCs) were detected in 7 (8.2%) patients [urethritis (2), wound phlegmon (2), scrotal hematomas (1), unrecovered urination (1), acute urinary retention (1)]. Of these, only 2 (2.4%) cases required additional surgical intervention. USs was detected in 14 (16.5%) patients during the follow-up period from 3 to 200 mo (median - 8 mo). USs surgical correction was required in 12 (14.1%) cases, systemic bougienage - in 2 (2.4%) cases. Independent risk factors for all complications were UTIs (OR=3.3; 95% CI - confidence interval (CI)=1,17 - 9,1;p=0.013), arterial hypertension (OR=2.3; 95% CI=1.02 - 5.05; p=0.044), bougienage (OR=2.4; 95% CI=1.08 - 5.33; p=0.031), the US multifocal localization (OR=2.8; 95% CI=1.28 - 6.05; p=0.011), and for stenoses, in particular, UTIs (OR=6.1; 95% CI=1.45 - 25.22; p=0.003), arterial hypertension (OR=2.6; 95% CI=1.05 - 6.40; p=0.035), previous hypospadias repair (OR=3.3; 95% CI=1.27 - 8.55; p=0.031) and EPCs (OR=4.1; 95% CI=1.74 - 9.41; p=0.004). The combination of unfavorable factors identified in multivariate analysis determines development from 21.8% to 49.9% cases of early and late complications. Conclusion. Urethrostomy may be the ultimate treatment for spongy complex US with an 82.4% primary success rate. The main factors negatively affecting the surgery outcomes are arterial hypertension, chronic kidney disease, US multifocal localization, previous bougienage, previous hypospadias repair, urethrocutaneous fistulas and EPCs.

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About the authors

M. I. Kogan

Rostov State Medical University

Email: dept_kogan@mail.ru
Honored Scientist of Russian Federation, M.D., Dr.Sc.(M), Full Prof.; Head, Dept. of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Course) Rostov-on-Don, Russia

V. V Glukhov

Rostov State Medical University

Email: docc.gvp@yandex.ru
M.D., Cand.Sc. (M), Assoc. Prof. (Docent); Assoc. Prof., Dept. of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Course) Rostov-on-Don, Russia

A. V Ilyash

Rostov State Medical University

Email: annailyash@yandex.ru
M.D., Cand.Sc.(M), Assistant, Dept. of Urology and Human Reproductive Health (with the Pediatric Urology and Andrology Course) Rostov-on-Don, Russia

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