Introduction

Posterior urethral strictures are complex urological conditions that occur after urethral injury from pelvic fractures1,2,3. For patients with posterior urethral strictures, end-to-end urethral anastomosis remains the gold standard procedure with the best outcome4,5. The success of the procedure depends not only on the delicate intra-operative management, but also on the postoperative care6,7. There are various issues related to the care of patients after posterior urethral end-to-end anastomosis. Firstly, the immediate postoperative dressing often involves the use of gauze combined with adhesive tape crossed with pressure, which often leads to allergic blisters and tension blisters on the patient’s skin after surgery, causing unnecessary skin damage. Secondly, the fixation of adhesive tape is not firm, and the tape often becomes loose when patients engage in active movement, which fails to achieve the effect of pressure bandaging and increases the risk of postoperative wound bleeding. In addition, patients need to inhibit erection to reduce cavernous bleeding after surgery, and estrogenic drugs have been used in the past, but they are ineffective and could lead to endocrine disorders in male patients.

In order to reduce the occurrence of complications in patients with urethral strictures after surgery and improve their quality of life, our department has independently developed multifunctional protective pants. These pants facilitate the daily life management and home care of patients after urethral stricture surgery, targeting three key aspects of postoperative care for urethral stenosis, and are expected to reduce the occurrence of postoperative complications.

The application of multifunctional protective pants in patients after posterior urethral stricture surgery has facilitated the observation of wound conditions, provided pressure dressing and catheter fixation, reduced the risk of catheter slippage, and at the same time avoided unnecessary traction and patient discomfort. The design of the perineal ice pack helps suppress abnormal erections after surgery, greatly improving patient comfort and satisfaction. Consequently, it effectively reduces the occurrence of postoperative complications in patients with urethral strictures, benefiting the surgical treatment outcomes. This study aims to observe the nursing application of multifunctional protective pants in patients with complex urethral strictures, evaluate their role in reducing complications during the nursing process, and improving the success rate of surgery. The following report provides details.

Materials and methods

General materials

A total of 50 patients who underwent posterior urethral surgery at our hospital from December 2021 to June 2023 were randomly selected as the study population. The patients were divided into the experimental group and the control group using the envelope randomization method. The control group consisted of 25 cases, with an age range of 22 to 66 years and a mean age of (39.4 ± 9.9) years. The experimental group consisted of 25 cases, with an age range of 17 to 60 years and a mean age of (36.2 ± 10.9) years. The differences between the general data of the two groups were not statistically significant (P > 0.05) and were comparable (Table 1). All patients and their family members were informed about the study and provided informed consent. The study protocol was approved by the medical ethics committee of our hospital.

The fabrication and production of the multifunctional protective pants

The multifunctional protective pants were invented by the Department of Urology of Sixth People’s Hospital of Shanghai and developed by JIQU Medical Technology Co., Ltd., commissioned. These protective pants are used for postoperative treatment of urethral strictures which are designed to fit closely to the patient’s buttocks, and the straps are threaded through the patient’s groin and adhered to the waistband to provide compression and dressing for the wound (Figure.1 A-C). The tightness of the straps can be adjusted according to the patient’s condition, effectively exerting pressure on the wound, inhibiting fluid leakage, promoting hemostasis, and facilitating tissue adhesion to promote wound healing, thus aiding in the postoperative recovery of the patient’s wound. The side pockets of the pants contain padding, which enhances comfort and provides a cool local microenvironment in the perineal area, reduced pain and the incidence of skin blisters as well as suppressed abnormal penile erection after surgery, thereby promoting wound healing (Figure.1D-F). Additionally, the protective pants are equipped with features such as a hook for suspending a urinary catheter, making it convenient for patients to carry a urine collection bag.

Methods

The control group took routine care after urethral stricture surgery. The diet should consist of high-protein, high-calorie, easily digestible foods, with an appropriate intake of vegetables, fruits, and coarse grains. Defecation was ideally be controlled until 3 days after surgery, as straining during defecation too early will increase wound tension, leading to urethral fistula and the leakage of urine through incompletely healed wounds. Besides, patients should be advised to drink plenty of water to increase urine volume, which helps flush the urinary tract and prevent residual urine from accumulating in the urethra, thus reducing the risk of wound infection. After surgery, the urinary catheter and negative pressure drainage tube were properly secured to ensure unobstructed drainage and prevent compression, bending, or detachment of the tubes. If the urine appears turbid or contains flocculent particles, the doctor was notified immediately for further evaluation. The urinary catheter was connected to a sterile anti-reflux urine collection bag, which was replaced twice a week, strictly according to aseptic operation. Postoperative antimicrobial therapy was administered to prevent infection and pressure should be reduced on the exposed wound. Furthermore, attention was paid to the blood supply to the perineal skin and the degree of scrotal swelling, observing for the presence of secretions or hematoma symptoms. The urethral orifice was cleaned with saline-soaked cotton balls twice daily to maintain cleanliness and dryness in the perineal area. In addition, postoperative administration of relevant antibiotics should be followed according to the physician’s instructions. If no seepage or exudate occurs for 3–5 days after surgery, there is no need to change the dressing for penile compression. Undoubtedly, patient temperature, pain, infection, poor wound healing, and bleeding should be recorded accurately.

Patients in the experimental group wore protective pants immediately after urethral stricture surgery (Figure.1G and H). In addition to the routine care provided to the control group, the experimental group received health education and guidance on how to wear and remove the protective pants for both patients and their family members to facilitate daily caregiving.

Fig. 1
figure 1

(A-C) Design diagram of the multifunctional protective pants; (D) Appearance of the multifunctional protective pants and matching ice pack; (E) Internal view of the multifunctional protective pants; (F) Skin blister caused by conventional adhesive pressure bandage; (G) Immediate postoperative pressure bandage of the multifunctional protective pants; (H) Frontal view of the abdomen of the multifunctional protective pants.

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Observation indexes

During the postoperative period until discharge, the occurrence of bleeding, abnormal body temperature, and other conditions in patients were observed in combination with routine blood tests and calcitoninogen results to assess patient’s infection status. Pain assessment for patients was conducted using a numerical scoring system during the three days and nine shifts handover. The primary endpoint indicator of the study is scrotal oedema, with other complications as secondary endpoints.

Patient-reported outcome measures

The PCQ designed for this study mainly consists of two main areas: patient subjective perception and comfort (Q1-4) and contribution to care and prognosis (Q5-10). The PCQ was completed by patients at follow-up.

Statistical methods

Data analysis and processing were performed using SPSS 22.0 statistical software. Measurement data were expressed as \((\bar{\mathcal{X}^{\pm s}})\) , and enumeration data were analyzed using \((\mathcal{X}^2)\) test. The t-test was used to assess differences, and a p-value less than 0.05 was considered statistically significant.

Results

The baseline of the random controlled patients

In total, 50 patients were enrolled between December, 2021, and June, 2023. Patients were randomly divided into two groups, the experimental group and the control group, with 25 patients in each group. Table 1 summarizes the clinical characteristics and baseline of various patients in each group, including age, history of urethral surgery, length of urethral defect, number of patients with dissection of Cavernous septum and splitting of pubic bone, intraoperative bleeding volume and follow-up time. There were no statistically significant differences in clinical characteristics and baseline between the two groups (Table 1).

Table 1 Patient characteristics of end-to-end urethral anastomosis for posterior urethral strictures.
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Comparison of the postoperative bleeding between patients in the control group and the experimental group

The incidence of bleeding was remarkably less than that of the control group on the first postoperative day, and the difference was statistically significant (P < 0.05). The time to remove negative pressure drainage and time to walk and hospitalization were decreased significantly (Table 2).

Table 2 Comparison of bleeding between patients in the control group and the experimental group (cases).
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Comparison of postoperative infection between patients in the control group and the experimental group

The incidence of abnormal body temperature, elevated blood leukocytes and procalcitonin, purulent discharge from the urethral orifice, positive secretion culture, and positive urine culture in the experimental group was significantly less than that in the control group within 5 days after surgery, and the difference was statistically significant (P < 0.05).

The use of multifunctional protective pants effectively reduces complications such as patient pain, infection, poor wound healing, and bleeding during the perioperative period, significantly increasing the success rate of surgery and patient satisfaction (Table 3).

Table 3 Comparison of postoperative infection between patients in the control group and the experimental group(cases).
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The patients’ evaluation of the usage of multifunctional protective pants

Table 4 Summarized the PCQ results. In terms of patient subjective perception and comfort, Twenty-three patients (92%) believed that the multifunctional protective pants was better than ordinary underwear and it improved their comfort level. Twenty-two patients (88%) found that it can reduce the time of erection. For promoting care and prognosis, twenty-five patients (100%) thought these pants are convenient for Doctors to change fresh dressing and observation of wounds. What’s more, twenty-two patients (88%) also believed that it can help to reduce the incidence of bleeding and tape allergies (Table 5).
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Table 5: Patient questionnaire of the use of multifunctional protective pants. Patients answering “Yes” on the questionnaire.

Comparison of complications between patients in the control group and the experimental group two months after surgery

Complication results are shown in Table 5. All postoperative complications were Clavian-Dindo grade I. There were no significant differences in the rates of self-urination, erection function and urinary incontinence two months after surgery. In comparison with the control group, the incidence of scrotum edema, skin allergic blisters, dropping of the dressing after walking and erection pain after surgery in experimental group were decreased significantly (P < 0.05) (Table 5).

Table 5 Comparison of syndromes between patients in the control group and the experimental group(cases) two months postoperatively.
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Discussion

The treatment of urethral stricture mainly involves open surgery8,9,10,11. Currently, there is extensive research on preoperative preparation and intraoperative procedures12, while postoperative care and recovery remain relatively understudied13. Postoperative care and preoperative preparation, as well as intraoperative procedures, are equally important in the management of urethral strictures and are integral parts of the treatment process14,15,16,17. They are crucial for surgical outcomes and should not be overlooked. If there is hematoma or inflammation in the urethral wound after surgery, or if the penis is abnormally erect resulting in excessive urethral tension, it may be necessary to perform a second surgical intervention to control bleeding, which may lead to failure in severe cases. Postoperative urethral wounds require compression dressings to inhibit tissue fluid leakage, promote hemostasis, and increase inter-tissue adhesion thereby promoting wound healing. Having a suitable urethral compression dressing shorts that also provide a cool local microenvironment in the perineal area can address these issues and bring significant benefits to patients.

After posterior urethral reconstruction surgery, scrotum oedema often occur postoperatively due to penile corpus cavernosum leucotomy, resection of the inferior border of the pubic symphysis, and exposure of the urethral spongiosum, and compression bandages are needed to achieve suppression of scrotal oedema. However, the previous method of bandaging after urethral and perineal surgery was the traditional gauze tape bandage, the disadvantage of which is that the tape is very easy to loosen, and the long strips of tape do not achieve uniform mechanical support for the perineum and scrotum. As a result, postoperative perineal oedema often occurred, requiring further treatment to control bleeding. This not only caused unnecessary physical and psychological trauma to patients but also imposed economic burdens and increased doctor-patient conflicts. In light of these issues, we have developed a multifunctional equipment that addresses bleeding complications following urethral reconstruction surgery from two perspectives. The first advantage lies in the adjustable perineal compression device. By adjusting the mechanical intensity of the perineal material through the use of straps, it effectively compresses the wound, reducing bleeding and minimizing tissue edema, thus promoting wound healing. Another advantage is the proactive approach to address erectogenic corpus cavernosum bleeding. We have incorporated programmable cooling ice packs into the perineal support material to cool the penis and urethral corpus cavernosum, reducing blood flow perfusion within the corpus cavernosum and effectively resolving corpus cavernosum bleeding. Furthermore, the protective pants are equipped with small features such as hooks for suspending urinary catheters, bladder fistula tubes, urine collection bags, and negative pressure drainage tubes. These designs facilitate the convenient carriage of these catheters by patients while preventing their accidental dislodgement. This protective hemostatic equipment is suitable for various perineal surgeries such as urethral stricture, testicular sheath effusion, testicular torsion, and perineal injuries, providing postoperative protection. In addition to its hemostatic function, it can accommodate various auxiliary devices, such as highly sensitive temperature and humidity pressure sensors, and erectile and urinary control nerve recovery stimulators. This invention significantly improves the safety of urethral surgeries and enables multifunctional patient recovery from a postoperative care perspective, making it an innovative breakthrough in both domestic and international contexts.

This study revealed that the incidence of postoperative scrotum edema in the experimental group was significantly lower than that in the control group (P < 0.05), indicating that the protective pants effectively exerted pressure on the wound. Within 5 days after surgery, the experimental group exhibited significantly lower rates of abnormal body temperature, elevated blood leukocytes and procalcitonin, purulent discharge at the urethral orifice, positive secretion cultures, and positive urine cultures compared to the control group. These differences were statistically significant (P < 0.05), which suggests that the protective pants reduced the occurrence of postoperative infections.

In conclusion, the protective pants effectively improve the occurrence of postoperative complications in patients with urethral strictures, benefiting the recovery of patients undergoing complex urethral reconstructive procedures and aiding in their prompt rehabilitation, thereby enhancing the success rate of the surgery. Nurses find the implementation of the pants feasible in practical settings, making it worthwhile to further promote their use.