Анастомозная уретропластика снижает риск рецидива сужения уретры после лучевой терапии рака простаты

Исследование показало, что анастомозная уретропластика эффективнее снижает риск рецидива стриктуры по сравнению с использованием лоскута слизистой оболочки щеки у пациентов с лучевым поражением. При этом частота осложнений и уровень удовлетворенности пациентов не различались между двумя методами лечения.

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TOPLINE Among patients who developed radiation-induced bulbomembranous urethral stenosis (BMUS) after prostate cancer radiotherapy, anastomotic urethroplasty was associated with a lower risk for stricture recurrence than buccal mucosa graft (BMG) onlay. METHODOLOGY - Researchers conducted a retrospective review of prospectively maintained databases from two institutions between 2001 and 2024 to compare outcomes after anastomotic urethroplasty and BMG onlay among patients with BMUS following prostate cancer radiotherapy. - The study included 212 patients (median age, 68 years) who underwent either anastomotic urethroplasty (n = 163) or BMG onlay (n = 49) for radiation-induced BMUS. All patients had at least one cystoscopic evaluation after surgery and a minimum follow-up of 12 months. - The primary outcome was stricture recurrence, defined as recurrent stricture < 16 Fr confirmed on cystoscopy. - Secondary outcomes were 90-day complications, patient-reported satisfaction, de novo erectile dysfunction, and de novo incontinence. TAKEAWAY - The estimated risk for stricture recurrence after anastomotic urethroplasty was 3.3% at 1 year, 5.0% at 2 years, and 6.8% at 10 years, whereas the risk after BMG onlay was 17%, 18%, and 20%, respectively (log-rank P = .01). - BMG onlay was associated with a higher risk for stricture recurrence in multivariable analysis (hazard ratio, 3.43; P = .046). - The rates of complications, patient satisfaction, erectile dysfunction, and incontinence did not differ significantly between the two techniques. IN PRACTICE "This data suggests that anastomotic urethroplasty may be the preferred reconstructive strategy for men with radiation-induced BMUS when technically feasible. However, the choice of technique should be individualized with BMG onlay remaining an important option for longer stenoses or when excision would risk undue tension with the recognition that durability may be lower, and follow-up must be vigilant," the authors wrote. SOURCE The study was led by Keith Rourke, MD, FRCSC, of the Department of Urology at the University of California, Irvine. It was published online on August 26 in The Journal of Urology. LIMITATIONS The retrospective study design could have introduced selection bias and confounding by indication. The data from two high-volume centers may make it hard to apply the results to other settings. DISCLOSURES The authors declared receiving no funding for the study and disclosed having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.