Hsiao Kenneth C, Baez-Trinidad Luis, Lendvay Thomas, Smith Edwin A, Broecker Bruce, Scherz Hal, Kirsch Andrew J
Department of Urology, Division of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, 1901 Century Boulevard, Atlanta, GA, USA.
J Urol. 2003 Sep;170(3):952-5. doi: 10.1097/01.ju.0000082321.98172.4e.
In an attempt to evaluate our experience with the treatment of pediatric urethral stricture disease we performed a retrospective review of patients undergoing direct vision internal urethrotomy (DVIU).
The computerized surgical logs at 2 pediatric hospitals were reviewed to identify patients who underwent DVIU between 1992 and 2001. Hospital and clinical charts were then reviewed. Many variables were analyzed, including patient age, etiology of stricture, technique and clinical outcomes. Minimum followup to be included in clinical outcome analysis was 12 months.
A total of 50 patients were identified (mean age 7.7 years, range 6 months to 17 years). The most common etiology for stricture formation was previous hypospadias repair (20 patients [40%]). Forty patients met the 12-month minimum followup requirement for clinical outcome analysis. Of these patients 20 (50%) had no symptoms to suggest recurrent stricture at a median of 2.0 years (mean 2.7 years, range 12 months to 7 years). Seventeen patients (42.5%) had symptoms of recurrent stricture at a median of 8 months (mean 13 months, range 2 months to 5 years). Technical factors did not influence the ultimate success or failure of the procedure.
DVIU provides a therapeutic option that successfully treats approximately half of the patients with a reasonably low complication rate. Complications following DVIU should not preclude its use as a therapeutic modality for the treatment urethral strictures in children. If the child fails the initial DVIU, repeat attempts at endoscopic correction of urethral stricture should be abandoned in favor of definitive urethroplasty.
为评估我们治疗小儿尿道狭窄疾病的经验，我们对接受直视下内尿道切开术（DVIU）的患者进行了回顾性研究。
回顾了两家儿童医院的计算机化手术记录，以确定1992年至2001年间接受DVIU的患者。然后查阅了医院病历和临床图表。分析了许多变量，包括患者年龄、狭窄病因、技术和临床结果。临床结果分析纳入的最短随访时间为12个月。
共确定50例患者（平均年龄7.7岁，范围6个月至17岁）。狭窄形成的最常见病因是既往尿道下裂修复术（20例患者[40%]）。40例患者达到临床结果分析的12个月最短随访要求。在这些患者中，20例（50%）在中位时间2.0年（平均2.7年，范围12个月至7年）时没有提示复发性狭窄的症状。17例患者（42.5%）在中位时间8个月（平均13个月，范围2个月至5年）时出现复发性狭窄症状。技术因素不影响手术最终的成功或失败。
DVIU提供了一种治疗选择，能成功治疗约一半的患者，且并发症发生率较低。DVIU后的并发症不应妨碍其作为治疗儿童尿道狭窄的一种治疗方式。如果患儿首次DVIU治疗失败，应放弃重复内镜矫正尿道狭窄的尝试，而选择确定性尿道成形术。
