医源性尿道狭窄诊断与治疗的单中心临床研究

Diagnosis and management of iatrogenic urethral stricture:a retrospective analysis of single medical center

目的:探索医源性尿道狭窄的诊断及治疗现状。方法:回顾性收集2012年1月~2015年2月单个尿道诊治中心收治的316例男性尿道狭窄患者的资料,包括年龄、原发病因、狭窄部位、狭窄长度、复发率及相应治疗方式。原发病因分为尿道下裂修复失败,导尿,尿道器械损伤,经尿道灌注化疗及其他,分析医源性尿道狭窄病因与狭窄部位、长度、治疗方式及手术成功率之间关系。结果:尿道器械损伤是医源性尿道狭窄最常见病因(176例,占55.69%),其次为导尿(82例,占25.95%)、经尿道灌注化疗(18例,占5.70%)、尿道下裂修复失败(14例,占4.43%),其他有26例(8.23%)。前尿道狭窄共212例(67.09%),后尿道60例(18.98%),多部位尿道44例(13.93%);平均狭窄长度为(3.4±2.32)cm,经尿道灌注化疗可导致长段尿道狭窄,平均狭窄长度达到(5.8±3.52)cm。尿道成形术是治疗医源性尿道狭窄最常用术式,占58.23%(184/316)。总体成功率84.50%(229/271),其中经尿道化疗灌注术后再狭窄率较其他病因类型明显更高。结论:我们的单中心研究表明尿道器械损伤是最常见的医源性尿道狭窄病因,且多数医源性尿道狭窄发生于前尿道。同时,医源性损伤类型与狭窄部位和长度均密切相关,不仅影响医源性尿道狭窄在治疗方式的选择,同时也关系到其预后情况。

Objective：To investigate the diagnosis and management of iatrogenic urethral stricture.Method：A retrospective analysis was done on 316 patients with iatrogenic urethral stricture who underwent treatment at one medical center of China from January 2012 to February 2015.Age,primary stricture etiology,stricture site,stricture length,corresponding treatment and success rate were identified for each patient.Primary etiology was classified as failed hypospadias repair,catheterization,urethral instrumentation,transurethral chemotherapy lavage and others.The databases were analyzed for the impact of different types of iatrogenic injury on the stricture location,length and treatment of urethral strictures,as well as the success rate.Result：Of the iatrogenic urethral stricture,the most common type was urethral instrumentations in 176（55.69%）,while other iatrogenic strictures were from catheterization in 82（25.95%）,failed hypospadias repair in 14（4.43%）,transurethral chemotherapy lavage in 18（5.70%）and others in 26（8.23%）.Strictures were anterior in 212（67.09%）,posterior in 60（18.98%）,multi segmental in 44（13.93%）.The mean stricture length was（3.4±2.32）cm and longest strictures were found in those caused by transurethral chemotherapy lavage（mean 5.8±3.52cm）.The most application technique was alternative urethroplasty and occupied 58.23%（184/316）.The overall success rate was 84.50%（229/271）,the lowest success rate was transurethral chemotherapy lavage.Conclusion：Our results showed that the urethral instrumentation is the most common etiology of iatrogenic urethral stricture,and most iatrogenic urethral stricture involves the anterior urethra,especially in the penile urethra.Meanwhile,the different types of etiology were closely related to location and length of strictures,moreover,it may play a vital role not only for treatment choice but also for the overall prognosis of iatrogenic urethral stricture.