尿道球囊扩张术治疗男性前尿道狭窄的初步尝试

Initial experiences of balloon dilation treating male anterior urethral stricture

目的探讨利用肾脏球囊套装行尿道球囊扩张术治疗男性前尿道狭窄的疗效。方法收集中国医科学大学附属第一医院2018年1月至2021年4月收治的44例男性前尿道狭窄患者的临床资料,所有患者利用肾脏球囊扩张套装(BARD,24 F,15 cm)进行尿道狭窄球囊扩张术,平均年龄(51±16)岁。病因主要包括创伤(15例,34.1%),医源性损伤(23例,52.3%),感染性(5例,11.3%),先天性尿道尿道畸形(1例,2.3%)。尿道狭窄长度1.0~9.5 cm。术后1年通过对比术前及术后IPSS,QOL,RUV及Q_(max)来评估前尿道狭窄球囊扩张术效果。结果44例患者均成功实施手术。平均手术时间(26±15)min,随访12~43个月。患者术前及术后IPSS为(27±7)分vs(14±9)分,QOL为(5.0±1.0)分vs(2.4±1.1)分,RUV为50(5,127)ml vs 11(2,35)ml,Q_(max)为(5.2±2.3)ml/s vs(17.9±6.8)ml/s(P均<0.05)。所有患者中除1例尿道下裂患者外,其余均对术后生活质量改善程度表示满意。结论球囊扩张术对于局部散发较短段且狭窄程度较轻的前尿道狭窄患者,能够提高其生活质量。

Objective To introduce the experiences in the management of anterior urethral stricture with balloon dilation.Methods The data of 44 male patients with anterior urethral stricture underwent dilation with balloon dilator(24 F,balloon length 15 cm,BARD,Covington,USA)from January 2018 to April 2022 in the First Affiliated Hospital of China Medical University were analyzed.The patients mean age was(51±16)years.The causes of urethral stricture were trauma(n=15,34.1%),iatrogenic injury(n=23,52.3%),urethritis(n=5,11.3%),and congenital malformation(n=1,2.3%).The estimated urethral stricture length was(1.0-9.5)cm.To evaluate the effect of balloon dilation of anterior urethral stricture by comparing preoperative and postoperative IPSS,QOL,RUV,Q_(max) at 12 months after surgery.Results Balloon dilation of urethral strictures was successfully performed in all patients.The mean operation time was(26±15)min.The follow-up time was 12-43 months.There were significant improvements in the IPSS[(27±7)vs(14±9)],QOL[(5.0±1.0)vs(2.4±1.1)],RUV[50(5,127)ml vs 11(2,35)ml],and Q_(max)[(5.2±2.3)ml/s vs(17.9±6.8)ml/s](P all<0.05).The patient with the history of hypospadias was not satisfied with the outcomes and received other intervention,the other patients feel satisfied with the condition.Conclusions Balloon dilation can improve the quality of life for patients with locally scattered,short segment,and mild anterior urethral stricture.