Dakum N K, Ramyil V M, Amu C O
Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.
Niger J Clin Pract. 2008 Dec;11(4):300-4.
The treatment of urethral stricture disease has remained a challenge over the years. The outcome has also been varied, with recurrent stricture being a major concern. We determined the outcome of urethroplasty with particular reference to the complications.
This was a retrospective study over 10 years (1995 to 2005) done at the Jos University Teaching Hospital, a tertiary health institution in the middle belt region of Nigeria.
There were a total of 32 patients whose ages ranged from 0.06 to 75 years (mean 25 yrs, SD 18.8 yrs,). Eleven patients had had one form of stricture treatment or the other. Stricture aetiology was traumatic in 21 (66%) and inflammatory in 6 (19%) patients. Of the 24 patients in whom the stricture length at operation was specified, six, 11 and seven were <2 cm, 2-4 cm and >4 cm respectively. The stricture was located in the anterior urethra in 18 (58.1%), posterior urethra in 2 (6.4%) and bulbomembranous in 11 (35.5%) of patients (unspecified in one). The bulbar urethra was the single most involved region, occurring in 12 (38.7%) patients. Resection and end to end anastomosis was done in 16 patients and replacement urethroplasty in 16 others (Quarteys in 12, Swinney in 3 and Orandi in 1). Complications observed were urinary tract infection in 12 (37.5%) patients, recurrent stricture 11 (34.4%) wound infection 10 (31.3%), oedema of genitalia 7 (21.9%), urethrocutaneous fistula 4 (12.5%), impotence 3 (9.4%), wound haematoma 2 (6.3%) and urinary incontinence in 1 (3.1%) patient(s).
Urinary tract infection, recurrence of the stricture and wound infection remain our major challenges. We recommend that in order to improve outcome, surgeons should regularly audit their practice and make necessary adjustments. In addition, urethroplasty should preferably be carried out by those with the cognate experience, while not compromising the need to teach younger colleagues.
多年来，尿道狭窄疾病的治疗一直是一项挑战。治疗结果也各不相同，其中复发性狭窄是一个主要问题。我们特别参照并发症情况确定了尿道成形术的治疗结果。
这是一项在尼日利亚中部地区的三级医疗机构乔斯大学教学医院进行的为期10年（1995年至2005年）的回顾性研究。
共有32例患者，年龄范围为0.06岁至75岁（平均25岁，标准差18.8岁）。11例患者曾接受过一种或另一种形式的狭窄治疗。狭窄病因中，21例（66%）为创伤性，6例（19%）为炎性。在24例术中明确狭窄长度的患者中，狭窄长度<2 cm、2 - 4 cm和>4 cm的分别有6例、11例和7例。18例（58.1%）患者的狭窄位于前尿道，2例（6.4%）位于后尿道，11例（35.5%）位于球膜部（1例未明确）。球部尿道是最常受累的单一区域，有12例（38.7%）患者。16例患者行切除端端吻合术，另16例患者行替代尿道成形术（12例行夸尔泰斯术式，3例行斯温尼术式，1例行奥兰迪术式）。观察到的并发症包括：12例（37.5%）患者发生尿路感染，11例（34.4%）复发性狭窄，10例（31.3%）伤口感染，7例（21.9%）生殖器水肿，4例（12.5%）尿道皮肤瘘，3例（9.4%）阳痿，2例（6.3%）伤口血肿，1例（3.1%）患者尿失禁。
尿路感染、狭窄复发和伤口感染仍然是我们面临的主要挑战。我们建议，为了改善治疗结果，外科医生应定期审查其操作并进行必要调整。此外，尿道成形术最好由有相关经验的医生进行，同时也不能忽视培养年轻同事的需求。
