良性前列腺增生手术相关尿道狭窄的原因、部位与处理

Causes,location and management of BPH surgery-related urethral stricture

目的:分析良性前列腺增生(BPH)手术相关尿道狭窄发生的可能原因并总结其临床处理经验。方法:回顾性分析37例BPH手术相关的尿道狭窄患者的临床资料,平均年龄68.5岁。有开放手术史12例,经尿道手术史25例;狭窄位于前尿道6例,位于后尿道31例;35例采用钬激光切开或结合经尿道狭窄段疤痕切除术。最大尿流率评价疗效。结果:2例因阴茎部尿道全程狭窄采用尿流改道外,其余均进行了尿道狭窄治疗手术。4例尿道外口狭窄手术后留置导尿管5～7 d,拔出导尿管后排尿通畅,最大尿流率均大于15 ml/s。31例膜部以上尿道狭窄患者中,留置导尿管2～4周,随访1～21个月(平均11.5个月),23例患者排尿满意,最大尿流率平均14.3 ml/s;8例患者排尿欠佳,最大尿流率<8 ml/s。结论:钬激光切开或结合经尿道狭窄段疤痕切除术是治疗BPH手术相关尿道狭窄的有效手段,认真地对待BPH手术可减少尿道狭窄的发生。

Objective： To analyze the possible causes of BPH surgery-related urethral stricture and summarize the experience in its clinical management. Methods ： The clinical data of 37 cases of BPH surgery-related urethral stricture were analyzed retrospectively. The patients averaged 68.5 years in age, of whom 12 had the history of open surgery, and 25 transurethral surgery. Anterior urethral stricture was found in 6 cases, and posterior urethra in stricture 31. Thirty-five cases were treated by holmium laser urethrotomy （HLU） or a combination of HLU with transurethral resection of the scar in the stenotic segment, and the results were evaluated based on the maximum flow rate （Qmax）. Results ： Two cases of full penile urethral stricture were treated by urinary diversion, and all the rest by urethral stricture surgery. Catheters were indweh in 4 cases of urethral stenosis for 5 - 7 days post-operatively, and smooth urination was achieved after their removal, with a Qmax of 〉 15 ml/s. Another 31 cases of membranous urethral stricture received catheter indwelling of 2 - 4 weeks and were followed up for 1 - 21 （ mean 11.5） months, of whom 23 experienced satisfactory voiding, with an average Qmax of 14.3 ml/s, and the other 8 poor voiding, with a Qmax of 〈 8 ml/s. Conclusion ： HLU or a combination of HLU with transurethral resection of the scar in the stenotic segment is an effective method for the treatment of BPH surgery-related urethral stricture. And conscientiously performed BPH surgery can reduce the incidence of urethral stricture.