Lemack G E, Foster B, Zimmern P E
Department of Urology, University of Texas Southwestern Medical Center, Dallas 75235-9110, USA.
Urology. 1999 Jul;54(1):37-43. doi: 10.1016/s0090-4295(99)00141-7.
To assess current practice patterns among urologists and to determine the perceived efficacy of urethral dilation. Urethral dilation has been advocated as a treatment for a variety of urologic disorders in women for several decades. Recent changes in Medicare reimbursement have again focused attention on this issue.
A 15-item questionnaire was mailed to all urologists actively practicing in the state of Texas (n = 642). The questionnaire consisted of 12 items about indications for, technique of, and outcome of urethral dilation, and three demographic questions regarding location and type of practice and number of years since completing residency.
A total of 194 physicians completed and returned the questionnaire (30%). Overall, 48.2% of practitioners used dilation six or fewer times during the past year; 23.7% reported having used it more than 30 times. Most urologists used dilation for urethral syndrome only (61.1%), although urethral stricture was also a frequently reported condition requiring dilation (29%). Most urologists trained within the past decade (60.9%) reported never offering dilation for urethral syndrome; only 34.2% of the remainder never offered it (P = 0.002). Urologists normally performed this procedure with local or no anesthesia (85%) and most commonly dilated to 32F (45%). Overall, 21% of urologists trained more than 10 years ago considered dilation very or extremely successful in treating urethral syndrome; 0 of 42 trained more recently considered it to be this successful (P = 0.014).
The use of urethral dilation in women remains controversial. Recently trained urologists use it less frequently and find it less efficacious than those who have been practicing for longer periods. Since such obvious biases exist, it is imperative that the clinical merit of urethral dilation be carefully scrutinized.
评估泌尿外科医生当前的治疗模式，并确定尿道扩张术的预期疗效。几十年来，尿道扩张术一直被提倡用于治疗女性的多种泌尿系统疾病。医疗保险报销政策最近的变化再次将人们的注意力聚焦在这个问题上。
向德克萨斯州所有在职的泌尿外科医生（n = 642）邮寄了一份包含15个条目的问卷。问卷包括12个关于尿道扩张术的适应症、技术和结果的问题，以及3个关于执业地点、执业类型和完成住院医师培训后年限的人口统计学问题。
共有194名医生完成并返还了问卷（30%）。总体而言，48.2%的从业者在过去一年中进行尿道扩张术的次数为6次或更少；23.7%的从业者报告使用次数超过30次。大多数泌尿外科医生仅将尿道扩张术用于尿道综合征（61.1%），尽管尿道狭窄也是报告中经常需要进行扩张术的疾病（29%）。大多数在过去十年内接受培训的泌尿外科医生（60.9%）报告从未为尿道综合征进行过扩张术；其余医生中只有34.2%从未进行过（P = 0.002）。泌尿外科医生通常在局部麻醉或无麻醉的情况下进行此操作（85%），最常扩张至32F（45%）。总体而言，10多年前接受培训的泌尿外科医生中有21%认为扩张术在治疗尿道综合征方面非常成功或极其成功；最近接受培训的42名医生中无人认为如此成功（P = 0.014）。
女性使用尿道扩张术仍存在争议。与从业时间较长的医生相比，近期接受培训的泌尿外科医生使用该方法的频率较低，且认为其疗效较差。由于存在如此明显的偏差，必须仔细审查尿道扩张术的临床价值。
