钬激光尿道内切开术联合留置尿管治疗男性前尿道2cm以上狭窄段21例效果分析

Analysis on efficacy of direct-vision internal urethrotomy with Holmium:YAG laser followed by retention of urethral catheter to treat anterior urethral stricture of more than 2cm long in twentyone male patients

目的分析钬激光尿道内切开术联合留置尿管治疗男性前尿道2 cm以上狭窄段的效果。方法男性前尿道狭窄患者21例,术前尿道造影显示前尿道呈细线样或串珠样,狭窄段长2～10 cm,平均(4.7±2.1)cm,狭窄段之后尿道明显扩张;行经直视下钬激光尿道内切开术和术后均留置尿管3个月的治疗。通过定期复查和电话询问随访预后。结果 21例术毕留置18F～20F尿管,术后5例出现急性附睾炎,3个月时拔除尿管。4个月时复查:尿道造影显示前尿道充盈较好、无明显狭窄,后尿道无扩张;最大尿流率16.6～23.5 mL/s,平均尿流率10.4～17.2 mL/s,平均(14.1±2.9)mL/s。12个月时最大尿流率13.5～19.4 mL/s,平均尿流率9.1～13.2 mL/s。21例随访5～60月,平均(37.2±20.3)月,均对排尿通畅状况满意。结论钬激光尿道内切开术联合留置尿管治疗男性前尿道2 cm以上狭窄段的效果持久,无需尿道扩张,创伤小、并发症较少。

Objective To analyze the efficacy of direct-vision internal urethrotomy with Holmium：YAG laser followed by retention of the urethral catheter in treatment of anterior urethral stricture of more than 2 cm in length.Methods Twentyone male patients with anterior urethral stricture of more than 2 cm in length underwent direct-vision internal urethrotomy with Holmium：YAG laser by means of ureteroscopy followed by retention of the urethral catheter for three months.Their voiding cystourethrography showed the length of anterior urethral stricture ranging from 2 cm to 10 cm（average 4.7±2.1 cm） and obvious dilation of other urethral segments after stricture.3F ～ 8F stents could go through the stricture segment at most.Their preoperative urology rates at maximum were 2.9 ～ 5 mL/s and average urology rate were 1.7 ～ 3.4 mL/s.Results 18F ～ 20F catheter were inserted through the urethra and into the bladder easily after DVIU and pulled out after three months.Acute epididymitis occurred in five patients during the three months.Their cystourethrography showed no obvious stricture and no obvious dilation in the whole urethra and their purely rates at maximum were 16.6 ～ 23.5 mL/s and average urology rate were 10.4 ～ 17.2 mL/s at four months after operation.And then,their purely rates at maximum were 13.5 ～ 19.4 mL/s and average urology rate were 9.1 ～ 13.2 mL/s at twelve months.They all have been followed up until now（5 ～ 60 months,average 37.2±20.3 months） and are satisfied with their fluency of urination.Conclusion The efficacy of direct-vision internal urethrotomy with Holmium： YAG laser followed by retention of the urethral catheter in treatment of anterior urethral stricture of more than 2 cm in length is satisfactory and persistent.This method is minimally invasive and could produce fewer complications and avoid urethral dilation and be accepted by patients completely.