Naudé André M, Heyns Chris F
Faculty of Health Sciences, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa.
Nat Clin Pract Urol. 2005 Nov;2(11):538-45. doi: 10.1038/ncpuro0320.
As a treatment for male urethral stricture, internal urethrotomy (IU) has the advantages of ease, simplicity, speed and short convalescence. Various modifications of the single cold-knife incision in the 12 o'clock position have been proposed, but there are no prospective, randomized studies to prove their claims of greater efficacy. IU can be performed as an outpatient procedure using local anesthesia, with an indwelling silicone catheter for 3 days after the procedure. Complications of IU are usually minor, including infection and hemorrhage. The reported success rate of IU varies, mainly because of differences in the definition of success and the duration of follow-up. Strictures can recur, usually within 3-12 months of IU. There are several known risk factors for recurrence: a previous IU, penile and membranous strictures, long (>2 cm) and multiple strictures, untreated perioperative urinary infection and extensive periurethral spongiofibrosis. Repeated IU might be useful in patients who have a stricture recurrence more than 6 months after the initial procedure, but repeat IU offers no long-term cure after a third IU, or if a stricture recurs within 3 months of the first IU. Such patients should be offered urethroplasty. Repeated IU followed by long-term self-dilation is an alternative option for men with severe comorbidity and limited life expectancy, or those who have failed previous urethroplasty. Overall, IU has a lower success rate (+/-60%) than urethroplasty (+/-80-90%), but if used for selected strictures, the success rate of IU could approach that of urethroplasty.
作为男性尿道狭窄的一种治疗方法，尿道内切开术（IU）具有操作简便、迅速且康复期短的优点。针对12点位置的单冷刀切口，人们提出了各种改良方法，但尚无前瞻性、随机研究来证实其疗效更佳的说法。IU可在局部麻醉下作为门诊手术进行，术后留置硅胶导尿管3天。IU的并发症通常较轻，包括感染和出血。IU报告的成功率各不相同，主要是因为成功的定义和随访时间存在差异。狭窄可能复发，通常在IU术后3 - 12个月内。已知有几个复发的风险因素：既往IU手术史、阴茎部和膜部狭窄、长（>2 cm）且多处狭窄、围手术期未治疗的泌尿系统感染以及广泛的尿道海绵体纤维化。对于初次手术后6个月以上出现狭窄复发的患者，重复IU可能有用，但在第三次IU后，或如果在首次IU后3个月内狭窄复发，重复IU并不能提供长期治愈效果。这类患者应接受尿道成形术。对于合并严重疾病且预期寿命有限的男性，或既往尿道成形术失败的男性，重复IU后长期自我扩张是一种替代选择。总体而言，IU的成功率（±60%）低于尿道成形术（±80 - 90%），但如果用于特定的狭窄，IU的成功率可能接近尿道成形术。
