Tarasov N I, SHarapov V F, Charyev M Ch, Alekseev O Iu, Marusev P E
Urol Nefrol (Mosk). 1990 Nov-Dec(6):57-9.
The paper presents the results of treatment of 172 patients of whom 50 had anterior urethral strictures and 122 posterior ones. In 167 of 172 patients urethral resection was performed irrespective of the site of constriction. The urethral patency was restored in 162 (97%) patients, whereas the operation was ineffective in 5 (3%). A relapse of stricture occurred in 16 (10%) of 162 patients in different periods following the operation, good results were obtained with repeated operations in 10 (6.2%). Sexual potency was observed in 30 (18.5%) patients. In patients with short strictures, optical urethrotomy by excising the scar tissue by a loop with a Storz resectoscope. The operation was ended with bladder drainage with a Foley No. 14 or No. 16 catheter for 1 to 2 weeks. All the operated patients showed good results within 4 to 12 months. No decreased sexual potency was seen in anybody. In addition, hydrocortisone solution was instilled around the scars in the area of anastomosis by using a urethroscope in 6 patients after urethral resection, but in one patient granulations were excised, which promoted improvement of therapy outcomes. In the authors' opinion, it is expedient to use irrigation urethroscopy as the choice of method for treating posttraumatic urethral strictures. Urethral resection is considered to be the basic therapy method. Optical urethrotomy is more preferable in strictures less than 1 cm in length. Following the resection urethroscopy is regarded to be indicated, which makes it possible to correct the outcomes of the basic operation.
本文介绍了172例患者的治疗结果,其中50例为前尿道狭窄,122例为后尿道狭窄。172例患者中有167例无论狭窄部位如何均进行了尿道切除术。162例(97%)患者尿道恢复通畅,5例(3%)手术无效。162例患者中有16例(10%)在术后不同时期出现狭窄复发,10例(6.2%)再次手术取得了良好效果。30例(18.5%)患者观察到性功能。对于短段狭窄患者,使用Storz电切镜的环形电极切除瘢痕组织进行直视下尿道切开术。手术结束时用14号或16号Foley导尿管进行膀胱引流1至2周。所有手术患者在4至12个月内均取得了良好效果。未发现任何人性功能下降。此外,6例患者在尿道切除术后通过尿道镜在吻合口周围瘢痕处注入氢化可的松溶液,但有1例患者切除了肉芽组织,这促进了治疗效果的改善。作者认为,采用灌洗尿道镜检查作为治疗创伤后尿道狭窄的首选方法是适宜的。尿道切除术被认为是基本的治疗方法。对于长度小于1 cm的狭窄,直视下尿道切开术更为可取。切除术后应进行尿道镜检查,这有助于纠正基本手术的效果。