European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males

被引:67
作者
Campos-Juanatey, Felix [1 ]
Osman, Nadir I. [2 ]
Greenwell, Tamsin [3 ]
Martins, Francisco E. [4 ]
Riechardt, Silke [5 ]
Waterloos, Marjan [6 ,11 ]
Barratt, Rachel [3 ]
Chan, Garson [7 ]
Esperto, Francesco [8 ]
Ploumidis, Achilles [9 ]
Verla, Wesley [6 ]
Dimitropoulos, Konstantinos [10 ]
Lumen, Nicolaas [6 ]
机构
[1] Marques de Valdecilla Univ Hosp, Urol Dept, Ave Valdecilla Ndeg25, Santander 39008, Cantabria, Spain
[2] Sheffield Teaching Hosp, Dept Urol, Sheffield, S Yorkshire, England
[3] Univ Coll London Hosp, Dept Urol, London, England
[4] Univ Lisbon, Santa Maria Univ Hosp, Dept Urol, Lisbon, Portugal
[5] Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
[6] Ghent Univ Hosp, Div Urol, Ghent, Belgium
[7] Univ Saskatchewan, Div Urol, Saskatoon, SK, Canada
[8] Univ Rome, Dept Urol, Campus Biomed, Rome, Italy
[9] Athens Med Ctr, Dept Urol, Athens, Greece
[10] Aberdeen Royal Infirm, Dept Urol, Aberdeen, Scotland
[11] AZ Maria Middelares, Div Urol, Ghent, Belgium
关键词
Urethra; Urethral stricture; Urethroplasty; Urethrotomy; Urethral dilatation; Diagnosis; Classification; Perioperative care; Follow-up; Guidelines; GRAFT BULBAR URETHROPLASTY; PATIENT DISSATISFACTION; RETROGRADE URETHROGRAM; SIU/ICUD CONSULTATION; RECURRENCE; IMPACT; OUTCOMES; RISK; SONOURETHROGRAPHY; RECONSTRUCTION;
D O I
10.1016/j.eururo.2021.05.032
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Context: Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice. Objective: To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease. Evidence acquisition: The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion. Evidence synthesis: Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function. Conclusions: Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up. Patient summary: Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture. (C) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:201 / 212
页数:12
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