Data_Sheet_1_v1_The treatment practices for anterior urethral strictures in China: A case-based survey.docx

ObjectiveTo investigate the treatment concept of Chinese urologists for anterior urethral strictures based on actual cases.
MethodsA self-designed case-based questionnaire was distributed to the members of Official WeChat account of Learning Union from March 19, 2020, to April 10, 2020. Questionnaires requested respondents' demographic information and responses to five cases of anterior urethral stricture: short obliterative bulbar urethral stricture caused by straddle injury (Case 1), idiopathic bulbar urethral stricture after failure of multiple endoscopic therapy (Case 2), iatrogenic long penile urethral stricture (Case 3), lichen sclerosis-related urethral stricture (Case 4), and anterior urethral stricture in indwelling catheter after multiple failure of endoscopic surgery (Case 5). Data was described by frequency and percentage.
ResultsA total of 1,267 valid anonymous questionnaires were received. Urethroplasty was recommended more frequently than endoscopic surgery (Case 1: 47.8% vs. 32.8%,Case 2: 42.5% vs. 33.8%, Case 3: 36.1% vs. 26.7%). Referrals patients to other urologists engaged in urethral repair and reconstruction account for a high portion of the treatment (Case 1:18.4%, Case 2:23.1%, Case 3:36.5%, Case 4:27.7%,Case 5:9.3%). Excision and primary anastomosis urethroplasty (EPA) was preferred for treatment of Case 1 (42.5%). For Case 2, the most popular choice was EPA (30.6%). Although the patient has a history of failure in endoscopic surgery, 33.8% of urologists continue to choose endoscopic surgery. For Case 3, 20.0% of urologists would perform oral mucosal urethroplasty. Surprisingly, 5.9% chose EPA. For Case 4, 37.3% of urologists selected meatotomy, 30.4% suggested that glans and urethral biopsies should be performed. 21.0% chose to use steroid ointment after surgery. For Case 5, 26.3% of the respondents believed that urethrography should be performed after removing catheter more than one week, if the urine is obstructed during the period, performing cystostomy firstly.
ConclusionsIn China, the concept of urethroplasty is more widely accepted than endoscopic surgery for the treatment of anterior urethral strictures. The concept of referral has been widely formed among Chinese urologists. Better understanding of the comprehensive treatment of lichen sclerosis related anterior urethral stricture and the principle of urethral rest should be strengthened.

研究目的：本研究旨在基于真实临床病例，探究中国泌尿外科医师针对前尿道狭窄（anterior urethral strictures）的诊疗理念。
研究方法：本研究于2020年3月19日至2020年4月10日期间，向「Learning Union学习联盟」官方微信公众号成员发放自行设计的基于病例的调查问卷。问卷内容涵盖受访者人口统计学信息，以及针对5例前尿道狭窄病例的诊疗决策：① 骑跨伤所致短段闭塞性球部尿道狭窄（病例1）；② 多次内镜治疗失败后特发的球部尿道狭窄（病例2）；③ 医源性长段阴茎部尿道狭窄（病例3）；④ 硬化性苔藓相关性尿道狭窄（病例4）；⑤ 多次内镜手术失败后留置导尿管的前尿道狭窄患者（病例5）。数据采用频次与百分比进行描述性统计。
研究结果：本研究共回收有效匿名问卷1267份。相较于内镜手术（endoscopic surgery），尿道成形术（urethroplasty）的推荐比例更高：病例1为47.8% vs 32.8%，病例2为42.5% vs 33.8%，病例3为36.1% vs 26.7%。将患者转诊至专职尿道修复与重建的泌尿外科医师的诊疗方案占比颇高：病例1为18.4%，病例2为23.1%，病例3为36.5%，病例4为27.7%，病例5为9.3%。针对病例1，医师首选切除吻合尿道成形术（excision and primary anastomosis urethroplasty, EPA），占比42.5%。针对病例2，最受青睐的诊疗方案同样为EPA（30.6%）；尽管该病例患者有内镜手术失败史，仍有33.8%的医师选择继续实施内镜手术。针对病例3，20.0%的医师会施行口腔黏膜尿道成形术，令人意外的是，尚有5.9%的医师选择EPA。针对病例4，37.3%的医师选择尿道外口切开术（meatotomy），30.4%的医师建议实施龟头及尿道活检，另有21.0%的医师建议术后使用类固醇软膏（steroid ointment）。针对病例5，26.3%的受访者认为，若患者在留置导尿管期间出现排尿梗阻，应先于拔除导尿管1周后行尿道造影（urethrography）检查，若梗阻未缓解则先行膀胱造瘘术（cystostomy）。
研究结论：在我国，相较于内镜手术，尿道成形术（urethroplasty）在治疗前尿道狭窄方面的诊疗理念已得到更广泛的认可。中国泌尿外科医师已普遍形成转诊共识，但针对硬化性苔藓相关性前尿道狭窄的综合诊疗以及尿道休息原则的认知，仍有待进一步加强。