Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
J Urol. 2011 May;185(5):1761-5. doi: 10.1016/j.juro.2010.12.038. Epub 2011 Mar 21.
Radiotherapy induced urethral strictures are often difficult to manage due to proximal location, compromised vascular supply and poor wound healing. To determine the success of urethroplasty for radiation induced strictures we performed a multi-institutional review of men who underwent urethroplasty for urethral obstruction.
A total of 30 men (mean age 67 years) underwent urethroplasty at 3 separate institutions. Excision with primary anastomosis was used in 24 of 30 patients (80%), with 4 of 30 requiring a genital fasciocutaneous skin flap and 2 a buccal graft. Hospitalization was less than 23 hours for 70% of the patients. Recurrence was defined as cystoscopic identification of urethral narrowing to less than 16Fr in diameter.
All strictures were located in the bulbomembranous region. Mean stricture length was 2.9 cm (range 1.5 to 7). External beam radiotherapy for prostate cancer was the etiology of stricture disease in 15 men (50%), with brachytherapy in 7 (24%) and a combination of the 2 modalities in 8 (26%). Successful urethral reconstruction was achieved in 22 men (73%) at a mean of 21 months. Mean time to stricture recurrence was 5.1 months (range 2 to 8). Two men required balloon dilation after stricture recurrence and none required urinary diversion. Incontinence was transient in 10% and persistent in 40%, with 13% requiring an artificial urinary sphincter. The rate of erectile dysfunction was unchanged following urethroplasty (47% preoperative, 50% postoperative).
Urethroplasty for radiation induced strictures has an acceptable rate of success and can be performed without tissue transfer techniques in most cases. Almost half of men will experience some degree of incontinence as a result of surgery but erectile function appears to be preserved.
由于放射治疗导致的尿道狭窄位置靠近近端，血管供应受损，伤口愈合不良，因此放射治疗后发生的尿道狭窄通常难以处理。为了确定尿道成形术治疗放射性狭窄的成功率，我们对在 3 家不同机构接受尿道成形术治疗尿道梗阻的男性进行了多机构回顾性研究。
共有 30 名男性（平均年龄 67 岁）在 3 家不同的机构接受了尿道成形术。24 例（80%）患者采用尿道切开吻合术，其中 4 例患者需要生殖器筋膜皮瓣，2 例患者需要颊黏膜移植。70%的患者住院时间不到 23 小时。复发定义为膀胱镜检查发现尿道狭窄直径小于 16Fr。
所有狭窄均位于球膜部。平均狭窄长度为 2.9cm（范围 1.5 至 7cm）。15 例（50%）患者的狭窄病因是前列腺癌的外照射放疗，7 例（24%）为近距离放疗，2 例（6%）为两种方法的联合应用。22 例（73%）患者在平均 21 个月后成功重建尿道。狭窄复发的平均时间为 5.1 个月（范围 2 至 8 个月）。2 例患者在狭窄复发后需要行球囊扩张，无患者需要行尿流改道。10%的患者出现短暂性尿失禁，40%的患者出现持续性尿失禁，13%的患者需要安装人工尿道括约肌。尿道成形术后勃起功能障碍的发生率没有变化（术前 47%，术后 50%）。
尿道成形术治疗放射性狭窄的成功率较高，在大多数情况下无需进行组织转移技术。近一半的患者会因手术而出现不同程度的尿失禁，但勃起功能似乎得以保留。
