腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁

Endoscopic holmium laser urethrotomy and regular urethral dilatation for the treatment of male urethral stricture and atresia

目的探讨腔镜下钬激光内切开治疗男性尿道狭窄及闭锁的效果及安全性。方法我院2007年4月～2009年11月收治男性尿道狭窄或闭锁病人17例,狭窄段长0.5～3.0cm,平均1.4cm,采用腔镜下钬激光狭窄段内切开治疗。术后留置尿管2～4周。拔除尿管后根据随访排尿状况定期作尿道扩张。结果 17例病例均取得手术成功,手术时间30～90min,平均40min,术后排尿显著改善,最大尿流率(Qmax)由术前平均6.5(2.8～11.5)ml/s提高到术后20.4(16.6～25.3)ml/s,无尿失禁、阳痿、尿瘘并发症。术后随访3～18个月,均排尿良好,无再狭窄发生,B超检查剩余尿<20ml。结论腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁安全有效,近期治疗效果良好,手术创伤小,并发症少,值得推广应用。

Objective To explore the effect and safety of endoscopic holmium laser urethrotomy for the treatment of male urethral stricture and atresia.Methods From April 2007 to November 2009,17 cases with urethral stricture or atresia underwent holmium laser urethrotomy by endoscope.The time of indewelling urethral catheter ranged from 2 to 4 weeks,and regular urethral dilatation was done according to urination status.Results The operating time was 30～90 minutes(mean 40 minutes).The operations of 17 cases were performed successfully.The urination was in proved dignificantly after operation.The maximal uroflow rate was elevated from preoperative average 6.5 ml /s to postoperative 20.4 ml /s.No urinary incontinence and urinary fistula were found after operation.Postoperative followup time ranged from 3 to 18 months.The urination status was good and no recurrence of urethral stricture was found.The residual urine was less than 20 ml with ultrasound examination.Conclusion Endoscope holmium laser urethrotomy and regular urethral dilatation is an effective and safe procedure and it has a good short-term therapeutic efficacy,less trauma and fewer postoperative complications in the treatment of male urethral stricture and atresia.