Zapalenie cewki moczowej – Rokowania, prognozy i postęp choroby

Zapalenie cewki moczowej
Rokowania, prognozy i postęp choroby

Zapalenie cewki moczowej (ZCM) charakteryzuje się dobrym rokowaniem przy prawidłowej diagnostyce i leczeniu, z kluczowym znaczeniem terapii partnerów seksualnych w celu zapobiegania reinfekcji. Nierzeżączkowe zapalenie cewki moczowej (NGU) jest zwykle samoograniczające się, jednak nieleczone infekcje przenoszone drogą płciową (STI) mogą prowadzić do powikłań, takich jak zwężenie cewki moczowej, zapalenie najądrzy, gruczołu krokowego, a także niepłodność. U kobiet 10%-40% przypadków ZCM może rozwinąć się w zapalenie narządów miednicy mniejszej (PID), co zwiększa ryzyko niepłodności i ciąży pozamacicznej. Wartości CRP (średnio 11,54±3,64 u pacjentów z niepowodzeniem leczenia vs. 9,59±2,77 u leczonych skutecznie, p≤0,025) oraz obecność cech liszaja twardzinowego w histologii cewki moczowej są istotnymi prognostykami niepowodzenia leczenia zwężenia cewki. Etapowa uretroplastyka wykazuje wyższy wskaźnik sukcesu (84,2%) w porównaniu do jednostopniowej (61,1%) u pacjentów z liszajem twardzinowym.

Zapalenie cewki moczowej – Rokowanie (przewidywanie wyników)

Naturalny przebieg choroby
Potencjalne powikłania
Przetrwałe zapalenie cewki moczowej
Znaczenie biomarkerów zapalnych i histologii w rokowaniu
Ocena ryzyka i badania przesiewowe
Rokowanie w przypadku raka cewki moczowej
Przyszłe kierunki badań
Kolejne rozdziały

Zapalenie cewki moczowej – Rokowanie (przewidywanie wyników)

Pacjenci z zapaleniem cewki moczowej mają zazwyczaj doskonałe rokowanie z wysokim wskaźnikiem wyleczeń, gdy schorzenie zostanie prawidłowo zdiagnozowane i leczone. Co istotne, kluczowe znaczenie ma wdrożenie leczenia partnerów seksualnych, szczególnie w przypadku określonych organizmów zakaźnych. Niestety, osoby aktywne seksualnie często ulegają ponownemu zakażeniu przez nieleczonych partnerów.¹

Naturalny przebieg choroby

Nierzeżączkowe zapalenie cewki moczowej (NGU) jest zasadniczo schorzeniem samoograniczającym się, które zwykle ustępuje bez powikłań w większości przypadków.² Wszyscy pacjenci z niepowikłanym zapaleniem cewki moczowej spontanicznie zdrowieją z leczeniem lub bez niego.³ W badaniach wykazano, że rokowanie w przypadku objawów przypominających zapalenie cewki moczowej jest dość dobre, nawet gdy nie można zidentyfikować patogenu.⁴

Jeśli zapalenie cewki moczowej jest leczone odpowiednim lekiem, pacjent powinien być całkowicie wyleczony. Należy jednak podkreślić, że również partnerzy seksualni muszą przyjmować leki. Jeśli tylko jedna osoba zostanie poddana leczeniu, infekcja może być przekazywana między partnerami wielokrotnie.⁵ Zapalenie cewki moczowej może z czasem ustąpić samoistnie, jednak jeśli jest spowodowane infekcjami przenoszonymi drogą płciową, te patogeny pozostaną w organizmie, a nieleczone STI mogą powodować problemy w późniejszym czasie.⁶

Potencjalne powikłania

Powikłania, takie jak zwężenie cewki moczowej, stenoza czy tworzenie ropni, są dość rzadkie. Współistniejące zapalenie najądrzy lub zapalenie gruczołu krokowego nie jest rzadkością.⁷ Coraz więcej dowodów wskazuje, że zakażenie chlamydialne narządów płciowych u mężczyzn może predysponować do niepłodności. Ponadto zarówno Chlamydia, jak i U. urealyticum mogą upośledzać plemniki i niekorzystnie wpływać na parametry nasienia.⁸

Zachorowalność z powodu zapalenia cewki moczowej u mężczyzn jest mniej powszechna (1%-2%), zazwyczaj przybierając formę zwężenia cewki moczowej lub stenozy z powodu tworzenia się blizn pozapalnych. Inne potencjalne powikłania zapalenia cewki moczowej u mężczyzn obejmują:

Zapalenie gruczołu krokowego
Ostre zapalenie najądrzy
Tworzenie ropni
Zapalenie odbytnicy
Niepłodność
Nieprawidłowości nasienia
Rozsiane zakażenie rzeżączkowe (DGI)
Reaktywne zapalenie stawów

⁹

U kobiet, około 10%-40% pacjentek z zapaleniem cewki moczowej ostatecznie rozwija zapalenie narządów miednicy mniejszej (PID), które może następnie powodować niepłodność i ciążę pozamaciczną wtórnie do tworzenia się blizn pozapalnych w jajowodach. Zapalenie narządów miednicy mniejszej może wystąpić nawet u kobiet z bezobjawowymi infekcjami.¹⁰

Rozsiane zakażenie rzeżączkowe (DGI) i reaktywne zapalenie stawów rozwijają się u mniej niż 1% kobiet z zapaleniem cewki moczowej. Reaktywne zapalenie stawów charakteryzuje się NGU, przednim zapaleniem błony naczyniowej oka i zapaleniem stawów oraz jest silnie związane z genem HLA-B27. Rzadkie, ale poważne powikłania DGI obejmują zapalenie stawów, zapalenie opon mózgowo-rdzeniowych i zapalenie wsierdzia.¹¹

Wskaźniki śmiertelności są minimalne u pacjentów z rzeżączkowym zapaleniem cewki moczowej lub NGU.¹²

Przetrwałe zapalenie cewki moczowej

W przypadkach przetrwałego zapalenia cewki moczowej po leczeniu w kierunku najbardziej prawdopodobnych organizmów, ważne jest zbadanie współistniejących zakażeń i innych, rzadziej występujących czynników przyczynowych. Szybka identyfikacja i leczenie są istotne, ponieważ kilka z tych czynników przyczynowych niesie ryzyko wywołania szkodliwych powikłań.¹³

Znaczenie biomarkerów zapalnych i histologii w rokowaniu

Zapalenie odgrywa bardzo ważną rolę w definiowaniu zwężenia cewki moczowej. Biomarkery zapalne mogą odgrywać istotną rolę w przewidywaniu podstawowej patofizjologii, jak również wyników leczenia.¹⁴

Badania wykazały negatywny wpływ zwiększonego poziomu białka C-reaktywnego (CRP) oraz obecności cech liszaja twardzinowego w histologii cewki moczowej na wyniki leczenia zwężenia cewki moczowej. Średnia wartość CRP wynosząca 11,54±3,64 u pacjentów z niepowodzeniem leczenia i 9,59±2,77 u pacjentów z pomyślnym wynikiem (p≤0,025) potwierdza istotną rolę biomarkerów zapalnych i histologii segmentu zwężenia w przewidywaniu wyniku operacji.¹⁵

Obecność cech liszaja twardzinowego, takich jak hiperkeratoza i ciężkie zapalenie w segmencie zwężenia, wskazywała na większe prawdopodobieństwo niepowodzenia.¹⁶ U pacjentów z potwierdzonym biopsją liszajem twardzinowym, etapowa uretroplastyka (z 19 pacjentów, 16 z sukcesem i 3 niepowodzenia) miała wskaźnik powodzenia 84,2%, a jednostopniowa uretroplastyka z błoną śluzową policzkową (z 18 pacjentów, 11 z sukcesem i 7 niepowodzeń) miała wskaźnik powodzenia 61,1%.¹⁷ Pacjenci z liszajem twardzinowym mają większą szansę nawrotu zwężenia, a etapowa uretroplastyka z błoną śluzową policzkową jest lepszą opcją niż uretroplastyka jednostopniowa.¹⁸

Ocena ryzyka i badania przesiewowe

Mężczyźni z bezobjawowym zapaleniem cewki moczowej mają 23 razy większe ryzyko wykrycia Chlamydia trachomatis i/lub Mycoplasma genitalium w porównaniu z osobami bez zapalenia cewki moczowej. Wysoka negatywna wartość predykcyjna (NPV) (97%) dla C. trachomatis i/lub M. genitalium u osób bez zapalenia cewki moczowej może być przydatna w ocenie ryzyka.¹⁹ To zmniejszone ryzyko prawdopodobnie dotyczy również partnera(ów) posiadających pozytywny wynik badania w kierunku STI, nawet jeśli wynik badania w kierunku mikroorganizmów jest negatywny, chociaż dowody są sprzeczne.²⁰

Aby w pełni ocenić ryzyko pacjenta (i jego partnera(ów)) posiadania którejkolwiek z infekcji, należy wziąć pod uwagę wiek, zachowanie seksualne, prezentację kliniczną oraz wyniki badań w kierunku zapalenia cewki moczowej.²¹ Wydzielin z cewki moczowej jest niezależnym wskaźnikiem predykcyjnym. Empiryczne leczenie antybiotykami jest zalecane u pacjentów z objawami zapalenia cewki moczowej wykazującymi pozytywne lub negatywne wyniki badania moczu, ale z wydzieliną z cewki moczowej.²²

Rokowanie w przypadku raka cewki moczowej

Chociaż rak pierwotny cewki moczowej nie jest typowym następstwem zapalenia cewki moczowej, warto wspomnieć o rokowaniu w tym schorzeniu. Według projektu RARECARE, jednoroczne i pięcioletnie względne wskaźniki przeżycia całkowitego (OS) u pacjentów z rakiem cewki moczowej w Europie wynoszą odpowiednio 71% i 54%.²³ Na podstawie dłuższej obserwacji, analiza bazy danych SEER, porównująca czynniki prognostyczne w rzadkich typach patologicznych pierwotnego raka cewki moczowej (n = 257) i powszechnych grupach patologicznych (n = 2651), wykazała 10-letnie wskaźniki OS odpowiednio 42,4% i 31,9%.²⁴

Wskaźniki przeżycia swoistego dla raka (CSS) po pięciu i dziesięciu latach wynosiły odpowiednio 68% i 60%.²⁵ Wiek (≥60 lat), rasa (inni vs. biali), stadium T (T3/T4 vs. TaT2) i stadium M (M1 vs. M0) były niezależnymi czynnikami prognostycznymi ryzyka dla OS i CSS w rzadkich wariantach patologicznych.²⁶

Czynniki prognostyczne gorszego przeżycia u pacjentów z pierwotnym rakiem cewki moczowej to:

Zaawansowany wiek (≥65 lat) i rasa czarna
Wyższe stadium, stopień złośliwości, zajęcie węzłów chłonnych i przerzuty
Zwiększony rozmiar guza i proksymalna lokalizacja guza
Podstawowa histologia (nie-urotelialnej lub niekonwencjonalnej)
Obecność współistniejącego raka pęcherza moczowego
Zakres leczenia chirurgicznego i modalność leczenia
Leczenie w ośrodkach akademickich
Lokalizacja nawrotu (cewkowa vs. nie-cewkowa)

²⁷

Przyszłe kierunki badań

Potrzebne są dalsze badania, aby określić efektywność kosztową badań w kierunku zapalenia cewki moczowej.²⁸ Wyraźnie pilnie potrzebne są dalsze badania, ze standaryzowaną metodologią, umożliwiającą szybkie przekładanie wyników na praktykę kliniczną, dotyczące etiologii, diagnostyki, akceptowalności i efektywności kosztowej badań w kierunku zapalenia cewki moczowej w oddziałach medycyny genitourologicznej.²⁹

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

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Materiały źródłowe

#1 Urethritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537282/
Patients generally have an excellent prognosis with a high cure rate when diagnosed and treated appropriately. Notably, it is crucial to address treatment for sexual partners when necessary, particularly for specific infectious organisms. Unfortunately, sexually active individuals are commonly reinfected by their untreated partners. […] In cases of persistent urethritis after treatment for the most likely organisms, it is important to investigate for coinfections and other less common causative agents. Prompt identification and treatment are important, as several of these causative organisms carry the risk of causing damaging complications. […] Nongonococcal urethritis is essentially a self-limited disorder that generally resolves without complications in most cases.
#2 Urethritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537282/
Patients generally have an excellent prognosis with a high cure rate when diagnosed and treated appropriately. Notably, it is crucial to address treatment for sexual partners when necessary, particularly for specific infectious organisms. Unfortunately, sexually active individuals are commonly reinfected by their untreated partners. […] In cases of persistent urethritis after treatment for the most likely organisms, it is important to investigate for coinfections and other less common causative agents. Prompt identification and treatment are important, as several of these causative organisms carry the risk of causing damaging complications. […] Nongonococcal urethritis is essentially a self-limited disorder that generally resolves without complications in most cases.
#3 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
All patients with uncomplicated urethritis spontaneously recover with or without treatment. […] Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant epididymitis or prostatitis is not uncommon. Increasing evidence shows that genital chlamydial infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum can impair sperm and adversely affect semen parameters. […] Approximately 10%-40% of women with urethritis eventually develop pelvic inflammatory disease (PID), which may subsequently cause infertility and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. […] Disseminated gonococcal infection (DGI) and reactive arthritis develop in fewer than 1% of female patients with urethritis. Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis.
#4 Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study | Scientific Reports
https://www.nature.com/articles/s41598-023-44733-z
The study evaluated the prevalence of gonorrhoea and chlamydia infections and find out other non-infectious diseases in sexually active young males with urethritis-like symptoms and their treatment outcomes. […] Urethral discharge was an independent predictor. […] Empirical antibiotic treatment is recommended for patients with urethritis symptoms showing positive or negative urinalysis results but with urethral discharge. […] The results further highlighted the high frequency of negative urinalysis and urine culture results in young male patients with gonorrhoea- and chlamydia-related urethritis and indicated the importance of urethral discharge (odds ratio: 32.6, p0.001) as an indicator for antibiotic treatment of gonorrhoea and chlamydia in these patients. […] The prognosis of urethritis-like symptoms was quite good, even when a pathogen could not be identified.
#5 Urethritis: Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/22858-urethritis
If you have urethritis and you’re treated with the correct medication, you should be cured entirely. It’s important to note that your sexual partners must also take the medication. If only one of you is treated, you can continue to pass the infection back and forth. […] Urethritis may clear up on its own in time. However, if it’s caused by sexually transmitted infections, those germs will stay in your system. Untreated STIs can cause problems later. These conditions include:
#6 Urethritis: Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/22858-urethritis
If you have urethritis and you’re treated with the correct medication, you should be cured entirely. It’s important to note that your sexual partners must also take the medication. If only one of you is treated, you can continue to pass the infection back and forth. […] Urethritis may clear up on its own in time. However, if it’s caused by sexually transmitted infections, those germs will stay in your system. Untreated STIs can cause problems later. These conditions include:
#7 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
All patients with uncomplicated urethritis spontaneously recover with or without treatment. […] Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant epididymitis or prostatitis is not uncommon. Increasing evidence shows that genital chlamydial infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum can impair sperm and adversely affect semen parameters. […] Approximately 10%-40% of women with urethritis eventually develop pelvic inflammatory disease (PID), which may subsequently cause infertility and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. […] Disseminated gonococcal infection (DGI) and reactive arthritis develop in fewer than 1% of female patients with urethritis. Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis.
#8 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
All patients with uncomplicated urethritis spontaneously recover with or without treatment. […] Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant epididymitis or prostatitis is not uncommon. Increasing evidence shows that genital chlamydial infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum can impair sperm and adversely affect semen parameters. […] Approximately 10%-40% of women with urethritis eventually develop pelvic inflammatory disease (PID), which may subsequently cause infertility and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. […] Disseminated gonococcal infection (DGI) and reactive arthritis develop in fewer than 1% of female patients with urethritis. Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis.
#9 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
Morbidity due to urethritis in males is less common (1%-2%), typically taking the form of urethral stricture or stenosis due to postinflammatory scar formation. Other potential complications of urethritis in males include prostatitis, acute epididymitis, abscess formation, proctitis, infertility, abnormal semen, DGI, and reactive arthritis. […] Mortality rates are minimal in patients with gonococcal urethritis or NGU.
#10 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
All patients with uncomplicated urethritis spontaneously recover with or without treatment. […] Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant epididymitis or prostatitis is not uncommon. Increasing evidence shows that genital chlamydial infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum can impair sperm and adversely affect semen parameters. […] Approximately 10%-40% of women with urethritis eventually develop pelvic inflammatory disease (PID), which may subsequently cause infertility and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. […] Disseminated gonococcal infection (DGI) and reactive arthritis develop in fewer than 1% of female patients with urethritis. Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis.
#11 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
All patients with uncomplicated urethritis spontaneously recover with or without treatment. […] Complications, such as stricture, stenosis, or abscess formation, are quite rare. Concomitant epididymitis or prostatitis is not uncommon. Increasing evidence shows that genital chlamydial infection in males may predispose to infertility. In addition, both Chlamydia and U urealyticum can impair sperm and adversely affect semen parameters. […] Approximately 10%-40% of women with urethritis eventually develop pelvic inflammatory disease (PID), which may subsequently cause infertility and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. […] Disseminated gonococcal infection (DGI) and reactive arthritis develop in fewer than 1% of female patients with urethritis. Reactive arthritis is characterized by NGU, anterior uveitis, and arthritis and is strongly associated with the gene for HLA-B27. Rare but serious complications of DGI include arthritis, meningitis, and endocarditis.
#12 Urethritis: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/438091-overview
Morbidity due to urethritis in males is less common (1%-2%), typically taking the form of urethral stricture or stenosis due to postinflammatory scar formation. Other potential complications of urethritis in males include prostatitis, acute epididymitis, abscess formation, proctitis, infertility, abnormal semen, DGI, and reactive arthritis. […] Mortality rates are minimal in patients with gonococcal urethritis or NGU.
#13 Urethritis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK537282/
Patients generally have an excellent prognosis with a high cure rate when diagnosed and treated appropriately. Notably, it is crucial to address treatment for sexual partners when necessary, particularly for specific infectious organisms. Unfortunately, sexually active individuals are commonly reinfected by their untreated partners. […] In cases of persistent urethritis after treatment for the most likely organisms, it is important to investigate for coinfections and other less common causative agents. Prompt identification and treatment are important, as several of these causative organisms carry the risk of causing damaging complications. […] Nongonococcal urethritis is essentially a self-limited disorder that generally resolves without complications in most cases.
#14 Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcomeâa single centre prospective study in the north-eastern part of India | African Journal of Urology | Full Text
https://afju.springeropen.com/articles/10.1186/s12301-021-00252-9
Inflammation plays a very important role in defining the urethral stricture. Inflammatory biomarkers may play an important role in predicting the underlying pathophysiology as well as outcome of surgery. […] The present study found a negative impact of increased CRP and the presence of features of lichen sclerosus in urethral histology with the outcome of urethral stricture disease. Thus, our study confirms that inflammatory biomarkers (CRP) and histology of stricture segment play a significant role predicting the outcome of surgery. […] The mean CRP of 11.543.64 in patients with failure and 9.592.77 in patients with successful outcome (p 0.025). […] The presence of features of lichen sclerosus like hyperkeratosis and severe inflammation in stricture segment predicted higher likelihood of failure.
#15 Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcomeâa single centre prospective study in the north-eastern part of India | African Journal of Urology | Full Text
https://afju.springeropen.com/articles/10.1186/s12301-021-00252-9
Inflammation plays a very important role in defining the urethral stricture. Inflammatory biomarkers may play an important role in predicting the underlying pathophysiology as well as outcome of surgery. […] The present study found a negative impact of increased CRP and the presence of features of lichen sclerosus in urethral histology with the outcome of urethral stricture disease. Thus, our study confirms that inflammatory biomarkers (CRP) and histology of stricture segment play a significant role predicting the outcome of surgery. […] The mean CRP of 11.543.64 in patients with failure and 9.592.77 in patients with successful outcome (p 0.025). […] The presence of features of lichen sclerosus like hyperkeratosis and severe inflammation in stricture segment predicted higher likelihood of failure.
#16 Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcomeâa single centre prospective study in the north-eastern part of India | African Journal of Urology | Full Text
https://afju.springeropen.com/articles/10.1186/s12301-021-00252-9
Inflammation plays a very important role in defining the urethral stricture. Inflammatory biomarkers may play an important role in predicting the underlying pathophysiology as well as outcome of surgery. […] The present study found a negative impact of increased CRP and the presence of features of lichen sclerosus in urethral histology with the outcome of urethral stricture disease. Thus, our study confirms that inflammatory biomarkers (CRP) and histology of stricture segment play a significant role predicting the outcome of surgery. […] The mean CRP of 11.543.64 in patients with failure and 9.592.77 in patients with successful outcome (p 0.025). […] The presence of features of lichen sclerosus like hyperkeratosis and severe inflammation in stricture segment predicted higher likelihood of failure.
#17 Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcomeâa single centre prospective study in the north-eastern part of India | African Journal of Urology | Full Text
https://afju.springeropen.com/articles/10.1186/s12301-021-00252-9
In biopsy-proven LS, staged urethroplasty (out of nineteen patients, sixteen were successful and three were failure) had a success rate of 84.2% and single-stage buccal mucosa urethroplasty (out of eighteen patients, eleven were successful and seven were failure) had a success rate of 61.1%. […] Those with lichen sclerosus (LS) have a higher chance of recurrence of stricture and staged buccal mucosa urethroplasty is a better option than the single-stage urethroplasty.
#18 Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcomeâa single centre prospective study in the north-eastern part of India | African Journal of Urology | Full Text
https://afju.springeropen.com/articles/10.1186/s12301-021-00252-9
In biopsy-proven LS, staged urethroplasty (out of nineteen patients, sixteen were successful and three were failure) had a success rate of 84.2% and single-stage buccal mucosa urethroplasty (out of eighteen patients, eleven were successful and seven were failure) had a success rate of 61.1%. […] Those with lichen sclerosus (LS) have a higher chance of recurrence of stricture and staged buccal mucosa urethroplasty is a better option than the single-stage urethroplasty.
#19 Asymptomatic men: should they be tested for urethritis?
https://pmc.ncbi.nlm.nih.gov/articles/PMC2598610/
More research is needed to determine the cost effectiveness of testing for urethritis […] Men with asymptomatic urethritis have 23 times the risk of having Chlamydia trachomatis and/or Mycoplasma genitalium detected compared with those with no urethritis. […] High negative predictive value (NPV) (97%) for C trachomatis and/or M genitalium in those without urethritis. […] This reduced risk also probably applies to their partner(s) testing positive for an STI even if they test microorganism negative, although the evidence is conflicting. […] To fully assess a patient’s risk (and that of their partner(s)) of having either infection, one needs to consider, age, sexual behaviour, clinical presentation, and the results of testing for urethritis. […] Given the increasing pressure to achieve the government’s 48-hour access target for departments of genitourinary medicine and the fact that better utilisation of resources must be part of the solution, this would seem a reasonable evidence-based compromise in the debate about testing for urethritis in asymptomatic men. […] Clearly more research, with standardised methodology, to allow rapid translation of findings into clinical practice, is urgently required on the aetiology, diagnosis, acceptability and cost effectiveness of testing for urethritis in departments of genitourinary medicine.
#20 Asymptomatic men: should they be tested for urethritis?
https://pmc.ncbi.nlm.nih.gov/articles/PMC2598610/
More research is needed to determine the cost effectiveness of testing for urethritis […] Men with asymptomatic urethritis have 23 times the risk of having Chlamydia trachomatis and/or Mycoplasma genitalium detected compared with those with no urethritis. […] High negative predictive value (NPV) (97%) for C trachomatis and/or M genitalium in those without urethritis. […] This reduced risk also probably applies to their partner(s) testing positive for an STI even if they test microorganism negative, although the evidence is conflicting. […] To fully assess a patient’s risk (and that of their partner(s)) of having either infection, one needs to consider, age, sexual behaviour, clinical presentation, and the results of testing for urethritis. […] Given the increasing pressure to achieve the government’s 48-hour access target for departments of genitourinary medicine and the fact that better utilisation of resources must be part of the solution, this would seem a reasonable evidence-based compromise in the debate about testing for urethritis in asymptomatic men. […] Clearly more research, with standardised methodology, to allow rapid translation of findings into clinical practice, is urgently required on the aetiology, diagnosis, acceptability and cost effectiveness of testing for urethritis in departments of genitourinary medicine.
#21 Asymptomatic men: should they be tested for urethritis?
https://pmc.ncbi.nlm.nih.gov/articles/PMC2598610/
More research is needed to determine the cost effectiveness of testing for urethritis […] Men with asymptomatic urethritis have 23 times the risk of having Chlamydia trachomatis and/or Mycoplasma genitalium detected compared with those with no urethritis. […] High negative predictive value (NPV) (97%) for C trachomatis and/or M genitalium in those without urethritis. […] This reduced risk also probably applies to their partner(s) testing positive for an STI even if they test microorganism negative, although the evidence is conflicting. […] To fully assess a patient’s risk (and that of their partner(s)) of having either infection, one needs to consider, age, sexual behaviour, clinical presentation, and the results of testing for urethritis. […] Given the increasing pressure to achieve the government’s 48-hour access target for departments of genitourinary medicine and the fact that better utilisation of resources must be part of the solution, this would seem a reasonable evidence-based compromise in the debate about testing for urethritis in asymptomatic men. […] Clearly more research, with standardised methodology, to allow rapid translation of findings into clinical practice, is urgently required on the aetiology, diagnosis, acceptability and cost effectiveness of testing for urethritis in departments of genitourinary medicine.
#22 Diagnosis and treatment outcomes of urethritis-like symptoms in young males: a retrospective cohort study | Scientific Reports
https://www.nature.com/articles/s41598-023-44733-z
The study evaluated the prevalence of gonorrhoea and chlamydia infections and find out other non-infectious diseases in sexually active young males with urethritis-like symptoms and their treatment outcomes. […] Urethral discharge was an independent predictor. […] Empirical antibiotic treatment is recommended for patients with urethritis symptoms showing positive or negative urinalysis results but with urethral discharge. […] The results further highlighted the high frequency of negative urinalysis and urine culture results in young male patients with gonorrhoea- and chlamydia-related urethritis and indicated the importance of urethral discharge (odds ratio: 32.6, p0.001) as an indicator for antibiotic treatment of gonorrhoea and chlamydia in these patients. […] The prognosis of urethritis-like symptoms was quite good, even when a pathogen could not be identified.
#23 EAU Guidelines on Primary Urethral Carcinoma – Uroweb
https://uroweb.org/guidelines/primary-urethral-carcinoma/chapter/prognosis
According to the RARECARE project, the one- and five-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively. […] Based on longer follow-up, an analysis of the SEER database, comparing prognostic factors in rare pathological types of primary urethral carcinoma (n = 257) and common pathological groups (n = 2,651), reported 10-year OS rates of 42.4% and 31.9%, respectively. […] Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively. […] Age ( 60 years), race (others vs. whites), T-stage (T3/T4 vs. TaT2) and M-stage (M1 vs. M0) were independent prognostic risk factors for OS and CSS in rare pathological variants. […] Prognostic factors of worse survival in patients with primary urethral carcinoma are: advanced age ( 65 years) and black race; higher stage, grade, nodal involvement and metastasis; increased tumour size and proximal tumour location; underlying (non-urothelial or unconventional) histology; presence of concomitant bladder cancer; extent of surgical treatment and treatment modality; treatment in academic centres; location of recurrence (urethral vs. non-urethral).
#24 EAU Guidelines on Primary Urethral Carcinoma – Uroweb
https://uroweb.org/guidelines/primary-urethral-carcinoma/chapter/prognosis
According to the RARECARE project, the one- and five-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively. […] Based on longer follow-up, an analysis of the SEER database, comparing prognostic factors in rare pathological types of primary urethral carcinoma (n = 257) and common pathological groups (n = 2,651), reported 10-year OS rates of 42.4% and 31.9%, respectively. […] Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively. […] Age ( 60 years), race (others vs. whites), T-stage (T3/T4 vs. TaT2) and M-stage (M1 vs. M0) were independent prognostic risk factors for OS and CSS in rare pathological variants. […] Prognostic factors of worse survival in patients with primary urethral carcinoma are: advanced age ( 65 years) and black race; higher stage, grade, nodal involvement and metastasis; increased tumour size and proximal tumour location; underlying (non-urothelial or unconventional) histology; presence of concomitant bladder cancer; extent of surgical treatment and treatment modality; treatment in academic centres; location of recurrence (urethral vs. non-urethral).
#25 EAU Guidelines on Primary Urethral Carcinoma – Uroweb
https://uroweb.org/guidelines/primary-urethral-carcinoma/chapter/prognosis
According to the RARECARE project, the one- and five-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively. […] Based on longer follow-up, an analysis of the SEER database, comparing prognostic factors in rare pathological types of primary urethral carcinoma (n = 257) and common pathological groups (n = 2,651), reported 10-year OS rates of 42.4% and 31.9%, respectively. […] Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively. […] Age ( 60 years), race (others vs. whites), T-stage (T3/T4 vs. TaT2) and M-stage (M1 vs. M0) were independent prognostic risk factors for OS and CSS in rare pathological variants. […] Prognostic factors of worse survival in patients with primary urethral carcinoma are: advanced age ( 65 years) and black race; higher stage, grade, nodal involvement and metastasis; increased tumour size and proximal tumour location; underlying (non-urothelial or unconventional) histology; presence of concomitant bladder cancer; extent of surgical treatment and treatment modality; treatment in academic centres; location of recurrence (urethral vs. non-urethral).
#26 EAU Guidelines on Primary Urethral Carcinoma – Uroweb
https://uroweb.org/guidelines/primary-urethral-carcinoma/chapter/prognosis
According to the RARECARE project, the one- and five-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively. […] Based on longer follow-up, an analysis of the SEER database, comparing prognostic factors in rare pathological types of primary urethral carcinoma (n = 257) and common pathological groups (n = 2,651), reported 10-year OS rates of 42.4% and 31.9%, respectively. […] Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively. […] Age ( 60 years), race (others vs. whites), T-stage (T3/T4 vs. TaT2) and M-stage (M1 vs. M0) were independent prognostic risk factors for OS and CSS in rare pathological variants. […] Prognostic factors of worse survival in patients with primary urethral carcinoma are: advanced age ( 65 years) and black race; higher stage, grade, nodal involvement and metastasis; increased tumour size and proximal tumour location; underlying (non-urothelial or unconventional) histology; presence of concomitant bladder cancer; extent of surgical treatment and treatment modality; treatment in academic centres; location of recurrence (urethral vs. non-urethral).
#27 EAU Guidelines on Primary Urethral Carcinoma – Uroweb
https://uroweb.org/guidelines/primary-urethral-carcinoma/chapter/prognosis
According to the RARECARE project, the one- and five-year relative overall survival (OS) rates in patients with urethral carcinoma in Europe are 71% and 54%, respectively. […] Based on longer follow-up, an analysis of the SEER database, comparing prognostic factors in rare pathological types of primary urethral carcinoma (n = 257) and common pathological groups (n = 2,651), reported 10-year OS rates of 42.4% and 31.9%, respectively. […] Cancer-specific survival (CSS) rates at five and ten years were 68% and 60%, respectively. […] Age ( 60 years), race (others vs. whites), T-stage (T3/T4 vs. TaT2) and M-stage (M1 vs. M0) were independent prognostic risk factors for OS and CSS in rare pathological variants. […] Prognostic factors of worse survival in patients with primary urethral carcinoma are: advanced age ( 65 years) and black race; higher stage, grade, nodal involvement and metastasis; increased tumour size and proximal tumour location; underlying (non-urothelial or unconventional) histology; presence of concomitant bladder cancer; extent of surgical treatment and treatment modality; treatment in academic centres; location of recurrence (urethral vs. non-urethral).
#28 Asymptomatic men: should they be tested for urethritis?
https://pmc.ncbi.nlm.nih.gov/articles/PMC2598610/
More research is needed to determine the cost effectiveness of testing for urethritis […] Men with asymptomatic urethritis have 23 times the risk of having Chlamydia trachomatis and/or Mycoplasma genitalium detected compared with those with no urethritis. […] High negative predictive value (NPV) (97%) for C trachomatis and/or M genitalium in those without urethritis. […] This reduced risk also probably applies to their partner(s) testing positive for an STI even if they test microorganism negative, although the evidence is conflicting. […] To fully assess a patient’s risk (and that of their partner(s)) of having either infection, one needs to consider, age, sexual behaviour, clinical presentation, and the results of testing for urethritis. […] Given the increasing pressure to achieve the government’s 48-hour access target for departments of genitourinary medicine and the fact that better utilisation of resources must be part of the solution, this would seem a reasonable evidence-based compromise in the debate about testing for urethritis in asymptomatic men. […] Clearly more research, with standardised methodology, to allow rapid translation of findings into clinical practice, is urgently required on the aetiology, diagnosis, acceptability and cost effectiveness of testing for urethritis in departments of genitourinary medicine.
#29 Asymptomatic men: should they be tested for urethritis?
https://pmc.ncbi.nlm.nih.gov/articles/PMC2598610/
More research is needed to determine the cost effectiveness of testing for urethritis […] Men with asymptomatic urethritis have 23 times the risk of having Chlamydia trachomatis and/or Mycoplasma genitalium detected compared with those with no urethritis. […] High negative predictive value (NPV) (97%) for C trachomatis and/or M genitalium in those without urethritis. […] This reduced risk also probably applies to their partner(s) testing positive for an STI even if they test microorganism negative, although the evidence is conflicting. […] To fully assess a patient’s risk (and that of their partner(s)) of having either infection, one needs to consider, age, sexual behaviour, clinical presentation, and the results of testing for urethritis. […] Given the increasing pressure to achieve the government’s 48-hour access target for departments of genitourinary medicine and the fact that better utilisation of resources must be part of the solution, this would seem a reasonable evidence-based compromise in the debate about testing for urethritis in asymptomatic men. […] Clearly more research, with standardised methodology, to allow rapid translation of findings into clinical practice, is urgently required on the aetiology, diagnosis, acceptability and cost effectiveness of testing for urethritis in departments of genitourinary medicine.