Comparison Between End-to-end Anastomosis and Buccal Mucosa Graft in Short Segment Bulbar Urethral Stricture: a Meta-analysis Study
ABSTRACT: to compare long term
follow-up between end-to-end urethroplasty and bucal mucosal graft for the management
of patients with short bulbar urethral stricture. Methods: we conducted a
meta-analysis of cohort studies. Literature research was performed on the
MEDLINE, Science Direct, and EMBASE database including studies from 1980
through 2014. The inclusion criteria were patients with short bulbar urethral
strictrure (sized ≤3 cm) undergoing end-to-end anastomosis (EE) and buccal
mucosa graft (BMG) with the complication of voiding symptoms and sexual
dysfunction ≥12 months. Pooled risk ratio (RRs) and 95% confdence interval (CIs)
were calculated using Mantzel-Haenzel method, while the heterogeneity were
determined through I2 value. Data analysis were done using Stata software
version 10.0 (StataCorp). Results: We analyze 10 studies in this meta-analysis.
Sexual dysfunction following EE and BMG were found in 24.6% (45/183) patients
and 9.1% (11/122) patients, respectively (overall RR 2.54; 95% CI: 1,44-4,47;
p=0.001). Voiding symptoms following EE and BMG were found in 14% (8/57)
patients and 12.5% (7/56) patients, respectively (overall RR 0.77; 95% CI:
0.3–2.0; p=0.591). Furthermore, stricture recurrent following EE and BMG were
8.4% (8/107) and 30% (14/46), respectively (overall RR 0.38; 95% CI: 0.17–0.84;
p=0.016). The effectiveness of EE and BMG were found to be equal as both
demonstrated few complications. BMG were found to be superior than EE terms of minimal
sexual dysfunction complication. On the contrary, EE were found to be superior
than BMG in terms of stricture recurence following short bulbar urethral
stricture surgery. Conclusion: BMG can be considered as the primary treatment
rather than EE for managing short urethral stricture cases.
Keywords: sexual dysfunction,
voiding symptoms, end-to-end anastomosis, buccal mucosa graft, anterior urethral
stricture
Author: Prahara Yuri, Irfan
Wahyudi, Arry Rodjani
Journal Code: jpkedokterangg160008
