Urethral stricture in men – standards for the provision of high-tech medical care
Authors:   Pirogov Russian National Research Medical University, Kotov S.V. ,   Moscow, Russia, Iritsyan M.M. ,   Pirogov Russian National Research Medical University; Moscow, Russia
Published: February 2021

Introduction. Urethroplasty is currently the gold standard for treating urethral strictures. The use of various grafts and flaps for urethroplasty requires extensive experience of the surgeon. These methods have fairly high efficiency. According to the decree of the Government of the Russian Federation dated 12/07/2019, the implementation of urethroplasty using vascularized skin flaps and mucous grafts are included in the standards of high-tech medical care in obligatory medical insurance system. Purpose of the study. To evaluate the effectiveness of high-tech medical care for men with narrowing of the urethra. Materials and methods. The results of surgical treatment of patient with urethral strictures at the clinic of urology of N.I. Pirogov Russian national research medical university since January 2016 to February 2020 were analyzed. The study included patients who underwent surgical treatment according to the high-tech medical care within obligatory medical insurance program. Over the entire period high-tech care was provided to 90 patients. The stricture length was 2-19 cm (median – 4 cm). In 47 (52,3%) patients, the stricture was localized in the bulbous section, in 14 (15,6%) in the penile section, in 16 (17,7%) – penile-bulbous section of the urethra, 3 (3.3%) patients had a meatostenosis. In 10 (11,1%) cased a panurethral stricture was diagnosed. As for etiological factors, the iatrogenic strictures were dominated. They were diagnosed in 53 (58,9%) patients, traumatic strictures were in 14 (15,6%) patients and in 10 (11,1%) cases strictures arose after unsuccessful hypospadias treatment. The median of the Qmax before surgery was 4.64 ml / sec. Cystostomy before surgery was in 20 (22.2%) patients. Results. The follow-up period was 6 to 38 months (median 14 months). The IPSS value for the observation period was 8 points. The average drainage period was 14 days (from 7-28 days). The average Qmax at the time of observation was 21.4 ± 10.9 ml/sec. During the observation, recurrence of urethral stricture was diagnosed in 9 (10%) patients. The overall treatment efficiency was 90%. Discussion. The results of dorsal and ventral urethroplasty with a buccal flap were compared according to the data of various authors, which showed that their effectiveness is the same and ranges from 90-95%. According to the world literature, the results of multi-stage urethroplasty show an efficiency within 78-100%. Comparable results of simultaneous urethroplasty with buccal and skin grafts are presented; in some cases, with extended strictures, it is possible to combine buccal and skin grafts. In our work, the effectiveness of treatment was 90% and is comparable to world results. The preference was given to the buccal graft, because the rate of complications is less than with skin grafts. Conclusion. Urethroplasty using grafts and flaps requires a lot of experience as a surgeon. It’s implementation should undoubtedly take place in expert centers. The effectiveness of surgical techniques in most cases is comparable with long-term observation. Most experts in the world prefer a buccal graft, which causes fewer complications and cosmetic defects.