男性尿道狭窄病因与治疗方式

Causes and management for male urethral stricture

目的:探讨男性尿道狭窄的病因,分析近年来尿道狭窄治疗策略,并对复杂性病例进行总结。方法:回顾性分析183例尿道狭窄住院患者资料,包括病因、狭窄部位和长度、治疗策略和相关合并症等。结果:183例尿道狭窄患者平均年龄为49.7岁,以51~65岁人群居多(38.8%,71/183);平均病程为64.7个月。外伤性病因占52.4%(96/183),其中骨盆骨折者占35.5%(65/183)、骑跨伤者占16.9%(31/183);医源性损伤者占29.5%。后尿道狭窄占45.9%(84/183),前尿道狭窄占44.8%(82/183),多段狭窄有6.6%(12/183)。99例(54.1%)接受了尿道狭窄段切除端端吻合术;40例(21.9%)接受腔内手术治疗,包括内窥镜下钬激光、冷刀内切开、内窥镜下电刀瘢痕切除、球囊扩张和尿道扩张术等。>65岁尿道狭窄患者27例(14.7%),经尿道前列腺电切术(transurethral resection of the prostate,TURP)术后并发尿道狭窄的比例达70.4%,显著高于整体样本的发生率(P<0.01)。结论:近3年男性外伤性和医源性尿道狭窄发生率有所增加。治疗方式从以内窥镜手术为主转变成以尿道成形术为主。

Objective： To explore the etiology of male urethral stricture, analyze the therapeutic strategies of urethral stricture, and summarize the complicated cases.Methods： Th e data of 183 patients with urethral stricture were retrospectively analyzed, including etiology, obstruction site, stricture length, therapeutic strategy, and related complications.Results： Th e mean age was 49.7 years, the average course was 64.7 months, and the constituent ratio of 51 to 65 years old patients was 38.8% （71/183）. The traumatic injury of patients accounted for 52.4% （96/183）, in which the pelvic fracture accounted for 35.5% （65/183） and the straddle injury accounted for 16.9% （31/183）. There were 54 cases of iatrogenic injury （29.5%）. The posterior urethral stricture accounted for 45.9% （84/183）, followed by the anterior urethral stricture （44.8%, 82/183） and the stenosis （6.6%, 12/183）. A total of 99 patients （54.1%） received the end to end anastomosis, and 40 （21.9%） were treated with intracavitary surgery, such as endoscopic holmium laser, cold knife incision, endoscopic electroknife scar removal, balloon dilation, and urethral dilation. In the patients over 65-years old, the urethral stricture rate was 14.8% and the complication rate （70.4%） for transurethral resection of the prostate （TURP） was significantly higher than that of all samples （P〈0.01）.Conclusion： Both the etiology of male urethral stricture and the treatment strategy have changed and the incidence of traumatic and iatrogenic urethral stricture has increased in recent 3 years. The main treatment of urethral stricture has been transformed from endoscopic surgery into urethroplasty.