Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica / Predictors of urethral stricture recurrence after endoscopic urethrotomy

Objetivo: El objetivo del trabajo fue analizar las variables clínico-demográficas de la serie y los factores predictores de recidiva de estenosis uretral tras uretrotomía endoscópica. Material y métodos: Se analizó retrospectivamente a 67 pacientes tratados mediante uretrotomía endoscópica tipo Sachse entre junio de 2006 y septiembre de 2014. Se excluyó a los intervenidos previamente de uretrotomía endoscópica o uretroplastia y se incluyó al resto de los pacientes que presentaban estenosis uretral. Se analizó edad, peso, hábito tabáquico, factores de riesgo cardiovascular, número, localización, longitud y etiología de la estenosis, uretrotomía previa, tiempo de sonda vesical y dilataciones posquirúrgicas. Se realizó un análisis univariado y multivariado mediante el test de chi-cuadrado o de Fisher y regresión logística para identificar las variables relacionadas con la recidiva. Resultados: El 37% recidivaron. La mayoría eran > 60 años (56,7%), obesos (74,6%), no fumadores (88%) y sin factores cardiovasculares (56,7%). La mayoría de las estenosis fueron únicas (94%), < 1 cm (82%), de uretra bulbar (64,2%), iatrogénicas (67,2%) y sin uretrotomía previa (89,6%). La mayoría llevaron sonda vesical durante < 15 días (85,1%) y no realizaron dilataciones posquirúrgicas (65,7%). Solamente la longitud de la estenosis resultó factor de riesgo independiente de recidiva (p = 0,025) con un riesgo relativo de 5,7 para un IC 95% (1,21-26,41). Conclusiones: En el tratamiento de la estenosis uretral mediante uretrotomía endoscópica, la longitud de la estenosis > 1 cm es el único factor que predice un incremento del riesgo de recidiva. No se encontró factores clínicos ni demográficos que condicionaran un incremento en la incidencia de recidiva. Del mismo modo, factores técnicos como incrementar el tiempo de sondaje vesical o las dilataciones uretrales no alteran el curso de la enfermedad, por lo que su uso rutinario es innecesario

Objective: The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. Material and methods: We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. Results: Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), < 1 cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for < 15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P = .025; relative risk, 5.7; 95% CI 1.21-26.41). Conclusions: In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length > 1 cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary

Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie / Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease

Introducción: La enfermedad de La Peyronie es un trastorno de la albugínea que condiciona incurvación peneana, y que precisa corrección quirúrgica cuando la deformidad dificulta la penetración. Material y métodos: Análisis retrospectivo de los resultados a corto plazo (longitud del pene, ángulo de incurvación y función eréctil) del tratamiento de la enfermedad de La Peyronie en 10 pacientes mediante cavernoplastia con injerto de mucosa oral. En esencia, el tratamiento incluyó la incisión de la placa fibrótica con bisturí eléctrico y el posterior recubrimiento del defecto cavernoso mediante un parche de mucosa oral. Al sexto mes medimos la longitud e incurvación peneanas, y recogimos la función eréctil mediante el cuestionario IIEF-5. Finalmente, se planteó a los pacientes la pregunta «¿volvería a repetir la misma intervención?». Resultados: La edad media fue de 53,4 años. El seguimiento promedio fue de 22,7 meses y la mediana de 24. La incurvación media preoperatoria fue de 68,5° (50-90°); la longitud media del pene de 11,2 cm (9-15) y el IIEF-5 medio de 16,1 (8-25). La longitud peneana media postoperatoria fue de 10,7 cm y el IIEF-5 medio de 18,9. Las diferencias entre los registros pre- y postoperatorios no alcanzaron significación estadística (p = ns). Un paciente desarrolló disfunción eréctil. En todos los casos la incurvación residual fue < 20°. Nueve pacientes (90%) aseguraron que repetirían la misma intervención. Conclusiones: Los resultados a corto plazo señalan que la cavernoplastia con injerto de mucosa oral puede ser una alternativa a los injertos tradicionales para la corrección quirúrgica de la enfermedad de La Peyronie

Background: Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. Material and methods: Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked 'Would you undergo the same operation again?'. Results: The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2 cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7 cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. Conclusions: The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease

Predictors of urethral stricture recurrence after endoscopic urethrotomy. / Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica.

OBJECTIVE: The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. MATERIAL AND METHODS: We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. RESULTS: Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), <1cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for <15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P=.025; relative risk, 5.7; 95% CI 1.21-26.41). CONCLUSIONS: In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length >1cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary.

Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease. / Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie.

BACKGROUND: Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. MATERIAL AND METHODS: Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked "Would you undergo the same operation again?". RESULTS: The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. CONCLUSIONS: The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.