Wang Linhui, Wang Zhixiang, Yang Bo, Yang Qing, Sun Yinghao
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Lasers Surg Med. 2010 Sep;42(7):620-3. doi: 10.1002/lsm.20934.
The outcome of thulium laser urethrotomy for patients with urethral stricture had not been reported. The purpose of this study was to evaluate outcome of endourethrotomy with the thulium laser as a minimally invasive treatment for urethral stricture.
Twenty-one consecutive patients with urethral stricture were evaluated by retrograde uroflowmetry, International Prostate Symptom Score (IPSS), and quality of life preoperatively at a single academic center. All patients were treated with thulium laser urethrotomy. All patients were followed up for 12-24 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram every 3 months. And all patients were followed up by mailed questionnaire, including IPSS and quality of life.
Retrograde endoscopic thulium laser urethrotomy was performed in all 21 patients. Most patients (N = 16; 76.2%) did not need any reintervention. Five patients developed recurrent strictures, of them two patients were treated by another laser urethrotomy, one patient was treated by open urethroplasty with buccal mucosa and the other two patients' reintervention were treated by urethral dilation. No intraoperative complications were encountered, although in 9.5% (N = 2) of patients, a urinary tract infection was diagnosed postoperatively. No gross hematuria occurred. Including two patients treated with repeat laser urethrotomy, 17(81.0%) showed good flow of urine (Q(ave)>16.0 ml/second) and adequate caliber urethra in retrograde urethrogram (RGU) 12 months after operation. Three (14.3%) patients showed narrow stream of urine (Q(ave)<8.0 ml/second) and urethral dilation was done every month or 2 months. There was one patient whose Q(ave) was between 8.0 and 16.0 ml/second. And this patient was treated by neither urethral dilation nor another laser urethrotomy.
The thulium laser urethrotomy was a safe and effective minimally invasive therapeutic modality for urethral stricture.
关于尿道狭窄患者行铥激光尿道切开术的结果此前尚未见报道。本研究的目的是评估铥激光尿道内切开术作为尿道狭窄微创治疗方法的效果。
在单一学术中心，对21例连续性尿道狭窄患者术前进行逆行尿流率测定、国际前列腺症状评分（IPSS）及生活质量评估。所有患者均接受铥激光尿道切开术治疗。术后所有患者均随访12 - 24个月，每3个月进行尿流率测定及逆行排尿性膀胱尿道造影检查。并通过邮寄问卷对所有患者进行随访，内容包括IPSS及生活质量。
所有21例患者均行逆行内镜铥激光尿道切开术。大多数患者（16例，76.2%）无需再次干预。5例患者出现复发性狭窄，其中2例再次行激光尿道切开术治疗，1例采用颊黏膜开放尿道成形术治疗，另外2例通过尿道扩张进行再次干预。术中未出现并发症，尽管9.5%（2例）的患者术后被诊断为尿路感染。未发生肉眼血尿。包括2例接受再次激光尿道切开术治疗的患者在内，17例（81.0%）患者术后12个月尿流良好（平均尿流率>16.0 ml/秒）且逆行尿道造影（RGU）显示尿道口径合适。3例（14.3%）患者尿流细（平均尿流率<8.0 ml/秒），每月或每2个月进行尿道扩张。有1例患者平均尿流率在8.0至16.0 ml/秒之间，该患者既未接受尿道扩张也未再次行激光尿道切开术治疗。
铥激光尿道切开术是治疗尿道狭窄安全有效的微创治疗方式。
