Yaşın üretroplasti sonucuna etkisi: eşleştirmeli analiz

Abstract

Amaç: Üretroplasti başarısı iyi vaskülarize bir uretraya, greft uygulanan prosedürlerde ise ayrıca neovaskülarizasyon için sağlıklı ve iyi vaskülarize greft yatağına bağlıdır. Yaşlı hastalar, penil ve uretral kan akışının azalmasına neden olabilecek artan komorbid yüke sahiptir. Bu nedenle, çalışmamızda üretroplasti uygulanan hastalarda yaşın cerrahi başarının bağımsız bir belirleyicisi olup olmadığını araştırmayı amaçladık.
Gereç ve Yöntemler: Kliniğimizde 2015-2020 yılları arasında üretroplasti (Eksizyon-primer anastomoz ve bukkal mukoza greft) uygulanan erkek hastaların verileri geriye dönük incelendi. Üretroplasti başarısı, en az bir yıllık takipte herhangi bir uretral girişim ihtiyacı olmaması olarak tanımlandı. Altmış yaş altı hastalar, darlık uzunluğu ve operasyon tipine göre 60 yaş ve üstü hastalarla 1:1 oranında eşleştirildi. Hasta özellikleri iki yaş grubu arasında karşılaştırıldı. Çok değişkenli lojistik regresyon analizi ile başarıya etki eden faktörler değerlendirildi.
Bulgular: Altmış yaş ve üstü 19 hasta (n= 8 eksizyon-primer anastomoz, n= 11 bukkal mukoza greft), <60 yaş olanlarla eşleştirildi. Ortalama yaş ve takip süresi <60 yaş ve ≥60 yaş grupları için sırayla 41,9±12,6 ve 67,9±4,8 yıl (p= 0,001), 27,3±8,7 ve 24,1±10,9 ay (p= 0,325) idi. Altmış yaş üstü grupta iatrojenik etiyoloji (p= 0,026), komorbidite (p= 0,007) ve koroner arter hastalığı (p= 0,027) varlığı daha yaygındı. Gruplar arasında diyabetes mellitus, vücut kitle indeksi, sigara kullanımı, geçirilmiş uretral cerrahi öyküsü, önceki uretrotomi intern sayısı, darlık yeri ve başarı oranları açısından anlamlı fark saptanmadı. Darlık uzunluğu başarıyı öngörmede anlamlı tek klinik faktördü (p= 0,044).
Sonuç: Üretroplasti başarısı darlık uzunluğundan etkilenmekte ancak yaştan etkilenmemektedir. Üretroplasti, darlık uzunluğu değerlendirildikten sonra yaşlı hastalarda da benzer başarı oranları ile yapılabilir.

Keywords

• uretra darlığı
• üretroplasti
• yaş

The impact of age on urethroplasty outcomes: a match pair analysis

Abstract

Objective: The success of urethroplasty depends on a well-vascularized urethra, and in graft procedures, also on a healthy and well-vascularized graft bed for neovascularization. Elderly patients have an increased comorbid burden that may result in decreased penile and urethral blood flow. Therefore, we aimed to investigate whether age is an independent determinant of surgical success in patients undergoing urethroplasty.
Material and Methods: The data of male patients who underwent urethroplasty (Excision-primary anastomosis and buccal mucosa graft) between 2015 and 2020 in our clinic were retrospectively analyzed. Urethroplasty success was defined as no urethral intervention required for at least one year of follow-up. Patients under the age of 60 were matched in a 1: 1 ratio with patients aged 60 and over, according to the length of the stricture and the type of operation. Patient characteristics were compared between the two age groups. Factors affecting success were evaluated with multivariate logistic regression analysis.
Results: Nineteen patients (n= 8 excision-primary anastomosis, n= 11 buccal mucosa graft) aged 60 years and older were matched with those <60 years of age. Mean age and follow-up period were 41.9±12.6 and 67.9±4.8 years (p= 0.001), 27.3±8.7 and 24.1±10.9 months (p= 0.325) for <60 years and ≥60 years old groups, respectively. Presence of iatrogenic etiology (p= 0.026), comorbidity (p= 0.007) and coronary artery disease (p= 0.027) were more common in the group over 60 years of age. No significant difference was found between the groups in terms of diabetes mellitus, body mass index, smoking, history of previous urethral surgery, number of previous direct vision internal urethrotomy procedures, location of stricture, and success rates. Stricture length was the only significant clinical factor predicting success (p= 0.044).
Conclusion: Urethroplasty success is affected by the length of the stricture, but not by age. Urethroplasty can be performed with similar success rates in elderly patients after evaluating the length of the stricture.

Keywords

• Urethral stricture
• urethroplasty
• age

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