| Objectives: Lower urinary tract pain is a common clinical symptom in patients with anterior urethral stricture and is rarely reported,but it seriously affects the patient's quality of life.This study retrospectively analyzes the factors of urinary tract pain associated with anterior urethral stricture,explores the clinical value of lower urinary tract pain in predicting the recurrence of anterior urethral stricture.Materials and methods: This retrospective study enrolled 121 anterior urethral stricture patients who was treated by urethral reconstruction or endovascular surgery in the First Affiliated Hospital of Fujian Medical University between January 2005 to January 2015.Collecting patient clinical data which included age,weight,height,body mass index,overweight,history of diabetes,history of smoking,stenosis etiology,stenosis position,stenosis length,preoperative lower urinary tract pain,postoperative lower urinary tract pain,postoperative lower urinary tract pain changes,preoperative urinary tract infection,surgical approach,preoperative maximum urinary flow rate,Postoperative maximum urinary flow rate change,postoperative recurrence of anterior urethral stricture.The lower urinary tract symptom score(Core Lower Urinary Tract Symptoms Score,CLSS)and the International Prostate Symptom Score(International Prostate,Symptom Score,IPSS)were used to assess the level of lower urinary tract pain,voiding function and quality of life.Statistical analysis was used to analyze the influencing factors of lower urinary tract pain associated with anterior urethral stricture,the relationship between lower urinary tract pain and patients' urination function and life quality,explore the clinical value of lower urinary tract pain in predicting the recurrence of anterior urethral stricture.Results: In 79(65%)of 121 patients with lower urinary tract pain,26 patients(21%)is rarely feeling pain,22 patients(18%)is sometimes getting pain,31 patients(26%)is frequently suffering pain,and 42 patients(35%)have no pain.Age and preoperative urinary tract infection between preoperative lower urinary tract pain group and non-preoperative urinary tract pain was statistically significant(P < 0.05),overweight,diabetes,smoking,stenosis etiology,stenosis position,stenosis length,postoperative lower urinary tract pain and postoperative lower urinary tract pain changes between preoperative urinary tract pain group and non-preoperative lower urinary tract pain group showed no significant difference(P > 0.05).There was a significant difference in CLSS score,IPSS score and quality of life(QOL)score between preoperative urinary tract pain group and non-preoperative lower urinary tract pain group(P < 0.05).In 121 patients,it include79 patients(65%)without pain and 42(35%)patients with lower urinary tract pain after operation,and 19 patients(16%)is rarely feeling pain,13 patients(11%)is sometimes getting pain,and 10 patients(8%)is frequently suffering pain.After operation,42 patients without preoperative pain include 31 patients(74%)without pain,6 patients(14%)rarely feeling pain,2 patients(5%)sometimes getting pain,and 3 patients(7%)frequently suffering pain after operation.,26 patients with preoperative rarely lower urinary tract pain include 17 patients(65%)without pain,4 patients(15%)rarely feeling pain,3 patients(12%)sometimes getting pain,and 2 patients(8%)frequently suffering pain after operation.22 patients with preoperative sometimes lower urinary tract pain include 13 patients(58%)without pain,3 patients(14%)rarely feeling pain,3 patients(14%)sometimes getting pain,and 3 patients(14%)frequently suffering pain after operation.31 patients with regular lower urinary tract pain include 18 patients(58%)without pain,6 patients(19%)rarely feeling pain,5 patients(16%)sometimes getting pain,and 2 patients(7%)frequently suffering pain after operation.In 121 patients after operation,48 patients(40%)had pain relief,14 patients(12%)had pain improvement,40 patients(33%)had no pain change,and 19 patients(15%)had pain aggravation.In 79 patients with preoperative pain,48 patients(61%)had pain relief,14 patients(18%)had pain improvement,9 patients(11%)had no pain change,and 8 patients(10%)had pain aggravation.Within 2 years after operation,31 patients(25%)have stenosis recurrence among 121 patients,in 23 patients who underwent endovascular surgery,3(13%)of the patients have stenosis recurrence;in 98 patients who underwent urethral reconstruction,87(89%)of the patients have stenosis recurrence.Univariate analysis shows a significant correlation between changes of postoperative pain,overweight,stenosis,length of stenosis,surgical approach and postoperative recurrence of stenosis(P < 0.05),but no significant correlation between age,diabetes,smoking,preoperative urinary tract infection,preoperative urinary tract pain,postoperative urinary tract pain,stenosis position,preoperative maximum urinary flow rate,Postoperative maximum urinary flow rate change and stenosis recurrence(P>0.05).Logistic regression analysis showed that postoperative lower urinary tract pain change,stenosis etiology and surgical approach are the main predictor of anterior urethral stricture recurrence(P < 0.05).Univariate analysis showed that Surgical approach between the postoperative lower urinary tract pain relief/improvement group and the postoperative lower urinary tract pain without change/aggravating group was statistically significant(P < 0.05),overweight,stenosis etiology,stenosis length between the postoperative lower urinary tract pain relief / improvement group and the postoperative lower urinary tract pain without change / aggravating group showed no significant difference(P > 0.05).Multivariate logistic regression analysis showed that the Surgical approach was an independent risk factor for postoperative lower urinary tract pain(P <0.05).Conclusions: Lower urinary tract pain is a common clinical symptom in patients with anterior urethral stricture,affects urinary function and reduces the quality of life.Age and urinary tract infection were influencing factors of preoperative lower urinary tract pain.Most patients underwent lower urinary tract pain to eliminate or improve after surgery.The postoperative recurrence rate of anterior urethral stricture after endovascular surgery is significantly higher than urethral reconstruction.Postoperative lower urinary tract pain change is a predictor of postoperative recurrence of anterior urethral stricture,patients with postoperative lower urinary tract pain aggravating have higher rate of postoperative recurrence of anterior urethral stricture. |
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