Outcomes of treatment of male urethral stricture：a multivariate analysis

目的：分析外伤性和前列腺术后尿道狭窄各种治疗方法的优缺点及影响因素，为临床上合理选择治疗方式、减少狭窄复发提出有益建议。方法：对本科64例外伤性和59例前列腺术后的尿道狭窄初次治疗共123例进行回顾性多因素分析。结果：64例外伤性尿道狭窄患者中，尿扩22例，20例（90．9％）复发；尿道内切开21例，16例（76．2％）复发；尿道端端吻合21例，4例（19％）复发；59例前列腺术后尿道狭窄中，尿扩16例，15例（93．6％）复发；尿道内切开37例，5例（13．5％）复发；6例切开膀胱行膀胱颈疤痕切开切除膀胱颈整形术，3例（50％）复发。结论：①经尿道疤痕切开切除治疗外伤性尿道狭窄，其疗效与狭窄长度有关，狭窄长度〈2cm复发率低，〉2121／1则复发率高。②尿道疤痕切除端端吻合治疗外伤性尿道狭窄，其疗效与狭窄长度、狭窄部位、既往手术史无关，与手术本身有关，即术中如彻底切除狭窄疤痕及坏死组织、吻合无张力则复发率低，反之则高。⑧尿扩适用于尿道黏膜下狭窄，不适用于合并有尿道海绵体纤维化的尿道狭窄。④尿道内切开是治疗前列腺术后尿道狭窄的首选方法且疗效好。

Objective：To investigate the advantages, disadvantages and outcome related factors of several treatments for urethral stricture caused by trauma or prostate surgery, so as to provide useful recommendations for proper selection of treatment options in clinical practice. Methods A retrospective muhivariate analysis was performed on the outcomes of initial treatment for 64 cases of traumatic and 59 of post-prostatectomy urethral stricture. Results For 64 cases of traumatic urethral stricture, the treatments included urethral dilation in 22 cases with relapse in 20 （90. 9% ）, urethrotomy in 21 cases with relapse in 16 （76. 2% ）, and anastomotic urethroplasty in 16 cases with relapse in 4 （ 19% ）. For 59 cases of post-prostatectomy urethral stricture, the treatments included urethral dilation in 16 cases with relapse in 15 （93.6%） , urethrotomy in 37 cases with relapse in 5 （ 13.5% ） , and bladder neck anaplasty through suprapubic cystotomy in 6 cases with relapse in 3 （50%）. Conclusion （ 1 ）The outcome of urethrotomy for treatment of traumatic urethral stricture depends on the length of the lesion. The rate of relapse may be low for strictures shorter than 2 cm as compared for those longer than 2cm by length. （2）The outcome of anastomotic urethroplasty for treatment of traumatic urethral stricture is correlated with surgical procedure itself but not with the length and site of stricture or previous surgical operations. In other words, radical removal of scarring and necrotic tissues and ensuring tension-free anastomosis can result in lower rate of relapse, and vice versa. （ 3 ） Urethra dilation offers benefit for treatment of submucosal stricture of the urethra but not with concomitant fibrosis of corpus cavernosum urethrae. （4） Urethrotomy may be a first-line and effective choice for postoperative strictures of the urethra.