内镜辅助下筋膜扩张器治疗男性尿道狭窄

Urethral Dilatation with the Renal Sheath Dilator under the Ureteroscope to Treatmale Urethrostenosis

目的:探讨内镜辅助下筋膜扩张器治疗男性尿道狭窄的方法及疗效。方法:对2015年9月~2017年9月共9例尿道狭窄临床治疗经验进行分析总结。本组患者均行椎管麻醉或者全麻,先于输尿管镜下或膀胱尿道镜下寻及尿道狭窄处,将斑马导丝直视下通过狭窄段置入膀胱,后用筋膜扩张器顺次递增方法扩张狭窄段尿道,保留导尿4~6周,并随访疗效。结果:本组9例患者均成功扩张尿道,并术后成功置入F20/22导尿管;手术时间平均25min,手术无明显失血;术后4~6周(平均40d)停保留导尿后正常排尿,随访1~24月未见尿道狭窄复发。结论:内镜辅助下筋膜扩张器可以有效治疗复杂男性尿道狭窄,方法简单易于掌握,适宜临床推广使用。

Objective：To evaluate the effect and safety of urethral dilatation with the renal sheath dilator under the ureteroscope for treatment of male patients with urethrostenosis.Methods：9 male patients receiving intraspinal anesthesia or general anesthesia with urethrostenosis were treated with urethral dilatation using the renal sheath dilator from Sep.2015 to Sep.2017 in our hospital.Under the ureteroscope,a Zebra urological guidewire was inserted through the stenosed urethra into the bladder and the stenosis was gradually dilated with the renal sheath dilator.All patients were inserted with a Foley catheter of proper size（ F20-F22） for 4-6 weeks after operation and followed up for 1 to 24 months.Results：The operation was success fully performed in all the 9 cases,with no urethral false passage,urethral perforation or urethra tearing.The average operation time was 25 min.All of the patients were cured,and the other none received urethroplasty for stenosis recurrence.The maximum flow rate was increased to higher than 15 m L/s after operation.Conclusion：Urethraldilatation with the renal sheath dilator under ureteroscope is a simple,safe and effective method for the treatment of urethrostenosis and worthy of clinical use.