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CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2020; 29(01): 026-031
DOI: 10.1055/s-0039-1698797
Original Article | Artículo Original
Reconstructive Urology/Urología Reconstructiva
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Urethral Reconstruction in a Reference Center in Eastern Colombia

Reconstrucción uretral en un centro de referencia del oriente colombiano
Verónica Tobar-Roa
1   Foscal Urological Center, Universidad Autónoma de Bucaramanga, Floridablanca, Colombia
,
Ana María Ortiz-Zableh 
2   Universidad Autónoma de Bucaramanga, Floridablanca, Colombia
,
Daniel José Mantilla-Rey
2   Universidad Autónoma de Bucaramanga, Floridablanca, Colombia
,
Guillermo Sarmiento-Sarmiento
1   Foscal Urological Center, Universidad Autónoma de Bucaramanga, Floridablanca, Colombia
› Author Affiliations
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Publication History

29 April 2019

21 August 2019

Publication Date:
01 November 2019 (online)

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Abstract

Introduction and Objectives Urethral stricture is a complex pathology of multiple etiologies, and of unknown incidence in our country. There are multiple options for the management of urethral stricture, from minimally invasive procedures, like urethral dilation or direct vision internal urethrotomy, to open surgical reconstruction using excision and primary anastomosis (EPA), or augmented urethroplasty with tissue graft.

The aim of the present study is to describe the characteristics of the patients managed with urethral reconstructive surgery in a reference center in eastern Colombia.

Methods Observational retrospective cohort study. Data was obtained from patients undergoing urethral reconstructive surgery at the institution from August 2013 to December 2017. All of the surgeries were performed by the same surgical team. The clinical and demographic variables were collected, and the validated urethral stricture surgery patient-reported outcome measure (USS-PROM) questionnaire was applied.

Results A total of 56 patients were included in the study, 26 patients (46.4%) underwent excision and primary anastomosis (EPA), and 30 (53.6%) underwent graft urethroplasty. The average age at the time of the intervention was 53.3 years old. The most frequent etiology was trauma, and the mean length of the stenosis was 1.7 cm for the EPA group, and 3 cm for the graft urethroplasty group (p = 0.009). A history of previous surgery was found in 66% of the patients, and radiotherapy in 2 patients.

The mean follow-up was of 14 months (range: 0–52 months), observing similar success rates for both techniques. Despite of the small sample size, when analyzing the Kaplan-Meier curves, we observed a tendency of a better response in the group without previous treatments and with stenosis with a length < 2 cm.

The rate of postoperative complications was of 23%, with no statistical difference between the 2 groups. The USS-PROM questionnaire was applied to 29 patients, finding that 27 out of 29 respondents were satisfied with the results of the procedure, and all of them would recommend it to another person.

Conclusions The results of our study show that urethral reconstruction surgery performed in an experienced center is associated with a good success rate, and that patients are satisfied with the result of the procedure.

Resumen

Introducción y objetivos La estrechez uretral es una patología compleja, de etiología múltiple e incidencia aún desconocida en nuestro país. Existen múltiples opciones de manejo dependiendo de las características de la estrechez, desde procedimientos mínimamente invasivos, como la dilatación uretral o uretrotomía interna, hasta la reconstrucción uretral abierta mediante escisión y anastomosis primaria (EPA) o cirugía de ampliación con injerto.

El objetivo de este estudio es describir las características de los pacientes llevados a cirugía reconstructiva uretral en un centro de referencia del oriente colombiano.

Métodos Estudio observacional de cohorte retrospectiva. Se obtuvieron datos de pacientes sometidos a cirugía reconstructiva uretral en la institución desde agosto de 2013 hasta diciembre de 2017. Todas las cirugías fueron realizadas por un mismo equipo quirúrgico. Se recolectaron las variables clínicas y demográficas, y se aplicó el cuestionario USS PROM validado a español.

Resultados Se incluyeron 56 pacientes en el estudio: 26 pacientes (46,4%) fueron sometidos a EPA y 30 (53,6%), a uretroplastía con injerto. La edad media al momento de la intervención fue de 53,3 años. La etiología más frecuente fue traumática, y la longitud media de la estenosis fue de 1,7 cm para el grupo de EPA, y de 3 cm para el grupo de uretroplastía con injerto (p = 0.009). Se encontró antecedente de cirugía en 66% de los pacientes, y radioterapia en 2 pacientes.

La media de seguimiento fue de 14 meses (0–52 meses), observando una tasa de éxito similar para ambas técnicas. A pesar de la muestra pequeña, al analizar las curvas de Kaplan-Meier observamos una tendencia a una mejor respuesta en aquellos pacientes sin tratamientos previos, y con estenosis menor de 2 cm.

La tasa de complicaciones postoperatorias fue de 23%, sin diferencias estadísticamente significativas entre ambos grupos. Se aplicó telefónicamente el cuestionario USS PROM a 29 pacientes, y se encontró que 27/29 estaban satisfechos con el resultado de la cirugía, y todos la recomendarían a otra persona.

Conclusiones Los resultados de nuestro estudio muestran que la cirugía de reconstrucción uretral realizada en un centro con experiencia se asocia a una buena tasa de éxito, y que los pacientes se encuentran satisfechos con el resultado de esta.

Keywords

urethra - urethral stricture - reconstructive surgical procedures - surgical anastomosis.

Palabras clave

uretra - estrechez uretral - procedimientos quirúrgicos reconstructivos - anastomosis quirúrgica
 

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