Imaji Reisuke, Dewan Paddy A
Urology Unit, Royal Children's Hospital, the Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Victoria, Australia.
Pediatr Surg Int. 2002 Sep;18(5-6):444-6. doi: 10.1007/s00383-002-0809-0. Epub 2002 May 14.
In patients with congenital posterior urethral obstruction, transurethral fulguration (TUF) is usually the treatment of choice if the patient is in a stable condition. However, few papers have described the proportion of patients who need further fulguration. We reviewed 83 boys with a congenital obstructive posterior urethral membrane (COPUM) to assess the role of re-do fulguration, as judged by prospective video recordings. Between December 1990 and March 2000, 83 boys (aged from newborn to 15 years) underwent cystourethroscopy for investigation of a urethral anomaly and were found to have a COPUM. TUF was performed endoscopically with a hook diathermy electrode. Two to 3 months later boys who had cauterisation had a further urethroscopy and diathermy as required. Of the 83 membranous lesions in the posterior urethra, 38 were considered severe, 20 moderate, and 21 minor. Four patients had inadequate data to be properly classified. Eighteen (47.4%) of the 38 patients who had a severe obstructive membrane equired further endoscopic intervention to obliterate residual membrane elements. As over 45% of patients who had a severe obstructing membrane needed further fulguration, it is important to follow patients carefully and to repeat the cystourethroscopy.
对于先天性后尿道梗阻患者，若病情稳定，经尿道电灼术（TUF）通常是首选治疗方法。然而，很少有论文描述需要进一步电灼的患者比例。我们回顾了83例患有先天性梗阻性后尿道瓣膜（COPUM）的男孩，通过前瞻性视频记录来评估再次电灼的作用。1990年12月至2000年3月期间，83名男孩（年龄从新生儿到15岁）因尿道异常接受了膀胱尿道镜检查，发现患有COPUM。使用钩形透热电极在内镜下进行TUF。两到三个月后，接受烧灼治疗的男孩根据需要进行了进一步的尿道镜检查和透热治疗。在后尿道的83个膜性病变中，38个被认为严重，20个中度，21个轻度。4例患者数据不足，无法进行恰当分类。38例患有严重梗阻性瓣膜的患者中有18例（47.4%）需要进一步的内镜干预以消除残留的瓣膜成分。由于超过45%患有严重梗阻性瓣膜的患者需要进一步电灼，因此仔细随访患者并重复膀胱尿道镜检查很重要。
