Comparative analysis of the results of treatment of patients with recurrent urethral stricture using platelet-rich plasma

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Resumo

Introduction. The treatment tactics of patients with recurrent urethral stricture requires an integrated approach. An increase in the treatment efficiency is possible not only through improvements in surgical technique, but also by influencing the pathogenetic mechanisms of the formation of urethral stricture and stimulating regeneration.

Aim. To evaluate the efficiency of reconstructive procedures using platelet-rich plasma in patients with recurrent urethral stricture.

Materials and methods. A comparative analysis of the results of surgical treatment of patients with recurrent urethral stricture with and without the use of platelet-rich plasma, who were treated at the University Clinic of Urology of Russian National Research Medical University named after N.I. Pirogov, was carried out. A total of 60 patients were included in the study. They were divided into the control (n=30) and the main group (n=30). There were no differences in length, median age, and localization of urethral stricture. The median maximum urinary flow rate preoperatively was 4.7 ml/s (1.7–11). According to etiological factors, there were 45 iatrogenic (75%), 7 traumatic (11.7%), 2 infectious strictures (3.3%) and 6 patients with hypospadias (10%).

Results. In the main group, end-to-end anastomotic urethroplasty was performed in 17, augmentation urethroplasty in 9, multi-stage urethroplasty/perineal urethrostomy in 4 cases. In the control group, end-to-end anastomotic urethroplasty was done in 24, augmentation urethroplasty in 4, multi-stage urethroplasty in 2 patients.

Efficiency in the main group was 93.3%. In 2 cases, recurrence of the stricture was seen. In the control group, the efficiency was 76.7%. There were 7 recurrences. The median period of catheterization was 14 and 7 days in the control and experimental groups, respectively. The frequency of infectious complications (urethritis, epididymitis, infected wound) was 6 times lower in the main group.

Median Qmax in the control group during follow-up was (min-max) 19.85 ml/sec (9–23.8), compared to 24 ml/sec (10–40) in the main group.

Conclusion. A combination of urethroplasty with a use of platelet-rich plasma improves the treatment outcomes of patients with recurrent urethral stricture. Reducing the length of bladder catheterization due to the stimulation of regeneration and the organization of the extracellular matrix allows to reduce the frequency of recurrence by 3 times. A decrease in the frequency of infectious complications also improves the results of surgical treatment, reduces the risk of recurrence and improves the quality of life of patients.

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Sobre autores

M. Iritsyan

Russian National Research Medical University. N.I. Pirogov; GKB No. 1 named after N.I. Pirogov

Email: misha-res@yandex.ru

Ph.D., assistant at the Ph.D. student at the Department of Urology and Andrology of Pirogov Russian National Research Medical University

Rússia, Moscow; Moscow

R. Guspanov

Russian National Research Medical University. N.I. Pirogov; GKB No. 1 named after N.I. Pirogov

Email: uroguspanov@yandex.ru

Ph.D., associate professor at the Department of Urology and Andrology of Pirogov Russian National Research Medical University, urologist at the Department of Urology of N.I. Pirogov City Clinical Hospital №1

Rússia, Moscow; Moscow

S. Pulbere

Russian National Research Medical University. N.I. Pirogov; GKB No. 1 named after N.I. Pirogov

Email: pulpiv@mail.ru

Ph.D., MD, Professor of the Department of Urology and Andrology of Pirogov Russian National Research Medical University, urologist at the Department of Urology of N.I. Pirogov City Clinical Hospital №1

Rússia, Moscow; Moscow

A. Klimenko

Russian National Research Medical University. N.I. Pirogov

Email: dr.klimenkoaa@yandex.ru

Ph.D. student at the Department of Urology and Andrology of Pirogov Russian National Research Medical University

Rússia, Moscow

R. Rakhmatov

Russian National Research Medical University. N.I. Pirogov

Email: rrahmatov7777@mail.ru

Resident of the Department of Urology and Andrology, Russian National Research Medical University. N.I. Pirogov

Rússia, Moscow

E. Alekberov

Russian National Research Medical University. N.I. Pirogov

Email: alekberov.e.m@yandex.ru

Ph.D. student at the Department of Urology and Andrology of Pirogov Russian National Research Medical University

Rússia, Moscow

A. Mantsov

Russian National Research Medical University. N.I. Pirogov

Email: mantsow2016@yandex.ru

Ph.D. student at the Department of Urology and Andrology of Pirogov Russian National Research Medical University

Rússia, Moscow

S. Kotov

Russian National Research Medical University. N.I. Pirogov; GKB No. 1 named after N.I. Pirogov

Autor responsável pela correspondência
Email: urokotov@mail.ru

Ph.D., MD, Head of the Department of Urology and Andrology of Pirogov Russian National Research Medical University

Rússia, Moscow; Moscow

Bibliografia

  1. Iritsyan M.M. The choice of a treatment method for recurrent urethral strictures in men. 14.01.23 Urology. Dissertation of the Candidate of Medical Sciences, Moscow, 2021. Russian (Ирицян М.М. Выбор метода лечения при рецидивных стриктурах уретры у мужчин. 14.01.23 Урология. Дисс. канд. мед. наук. М., 2021).
  2. Meeks J.J., Erickson B.A., Granieri M.A. et al Stricture recurrence after urethroplasty: a systematic review. J. Urol. 2009;182:1266–1270.
  3. Mundy A.R., Andrich D.E. Urethral strictures. BJU Int. 2011;107:6–26. doi: 10.1111/j.1464-410X.2010.09800.x.
  4. Kotov S.V., Belomyttsev S.V., Guspanov R.I. and others. Iatrogenic urethral strictures in men. Urology. 2018;4:56–63 DOI: https://dx.doi.org/10.18565/urology.2018.4.56-63. Russian (Котов С.В., Беломытцев С.В., Гуспанов Р.И. и др. Ятрогенные стриктуры уретры у мужчин. Урология. 2018;4:56–63) Doi: https://dx.doi.org/10.18565/urology.2018.4.56-63
  5. Cheng L. et al. A brief review on anterior urethral strictures. Asian Journal of Urology. 2018;5(2):88–93. doi: 10.1016/j.ajur.2017.12.005.
  6. Nagler A., Gofrit O., Ohana M. et al. The effect of halofuginone, an inhibitor of collagen type I synthesis, on urethral stricture formation: in vivo and in vitro study in a rat model. J. Urol. 2000;164:1776–1780.
  7. Meheux C.J., McCulloch P.C., Lintner D.M. et al. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2016;32(3):495–505. Doi: 10.1016/ j.arthro.2015.08.005.
  8. Mishra A., Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am. J. Sports Med. 2006;34(11):1774–1778.
  9. Singh B., Goldberg L.J. Autologous Platelet-Rich Plasma for the Treatment of Pattern Hair Loss. Am. J. Clin. Dermatol. 2016;17(4):359–367. doi: 10.1007/s40257-016-0196-2.
  10. Толстов Д.А., Богдан В.Г. Тромбоцитарные концентраты: классификация, технологии получения, биологические эффекты. Военная медицина. 2012;3:141–144.
  11. Медведев В.Л., Коган М.И., Михайлов И.В. и др. Аутологичная плазма обогащённая тромбоцитами: что это и для чего? Вестник урологии. 2020;8(2):67–77. doi: 10.21886/2308-6424-2020-8-2-67-77.
  12. Tavukcu H.H., Aytaç Ö., Atuğ F. et al. Protective effect of platelet-rich plasma on urethral injury model of male rats. Neurourol. Urodyn. 2018;37(4):1286‒1293. doi: 10.1002/nau.23460.
  13. Karpushchenko E.G. Clinical and morphological adaptation of the buccal flap in urethral surgery: dis. ... candidate of Medical Sciences: 14.01.23. St. Petersburg, 2018. 151 p. Russian (Карпущенко Е.Г. Клинико-морфологическая адаптация буккального лоскута в уретральной хирургии: дисс. канд. мед. наук: 14.01.23. СПб., 2018. 151 с.).
  14. Scarcia M., Maselli F.P., Cardo G. et al. The use of autologous platelet rich plasma gel in bulbar and penile buccal mucosa urethroplasty: Preliminary report of our first series. Arch. Ital. Urol. Androl. 2016;88(4):274–278. doi: 10.4081/aiua.2016.4.274.
  15. Kotov S.V., Iritsyan M.M., Guspanov R.I., Raksha A.P., Magnaeva A.S., Zhilov M.S., No I.I., Alekberov E.M., Bazarkin A.K. Evaluation of the regenerative potential of platelet-enriched plasma in urethroplasty in an experimental model. Urology. 2020;4:27–35. Russian (Котов С.В., Ирицян М.М., Гуспанов Р.И., Ракша А.П., Магнаева А.С., Жилов М.С., Но И.И., Алекберов Э.М., Базаркин А.К. Оценка регенеративного потенциала плазмы, обогащенной тромбоцитами при уретропластике в экспериментальной модели. Урология. 2020;4:27–35).
  16. Eryilmaz R., Şimşek M., Aslan R. et al. The effect of plasma rich platelet graft on post-operative complications in mid-penile hypospadias. Andrologia. 2020;00:e13652. Doi: 10.1111/ and.13652.

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2. Fig. 1. Surgical picture, stages of the operation

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3. Fig. 2. Patient K. Pericoheteric urethrography on the 7th day after surgery [1]

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