Department of Surgery, M.G.M Medical College & M.Y.H group of Hospitals, Indore, Madhya Pradesh, India.
Int Braz J Urol. 2011 May-Jun;37(3):362-9; discussion 369-70. doi: 10.1590/s1677-55382011000300010.
Urethral strictures remain a reconstructive dilemma, due to high incidence of recurrence and less than satisfactory outcomes. Even experienced surgeons following strict surgical principles have not achieved optimal results, leading us to think whether the etiology of strictures dictate the outcome . We evaluated this "cause-effect" relationship highlighting the significance of the etiology on the overall prognosis of urethral strictures.
A total of 302 males with urethral strictures were assessed (both retrospectively and prospectively) over a period of ten years. The preoperative evaluation was performed by retrograde urethrogram, urethrosonogram, and uroflowmetry and categorized, based on etiology: a) as post traumatic, b) post infective, c) iatrogenic or d) unknown. Traumatic strictures were subjected to pelvic X-ray and sub-categorized into grades A, B and C, following the TILE classification. Patients were operated; with tunica albuginea urethroplasty for anterior strictures and U shape prostato-bulbar anastomosis for posterior strictures.
Traumatic strictures accounted for 54% of cases. 127 of the 302 patients were treated using Tunica Albuginea Urethroplasty, while U shaped Prostatobulbar Anastomosis was performed on others. Post traumatic strictures had best outcome whereas post infective strictures had the worse outcome. Among strictures following pelvic fractures, TILE grades A and B had a better post operative course as compared to TILE C. Overall complication rate was 13.24%.
Our study demonstrated that etiology of urethral strictures may play a vital role for the overall prognosis of urethral strictures.
尿道狭窄仍然是一个重建的难题，由于复发率高，治疗效果不尽如人意。即使是遵循严格手术原则的经验丰富的外科医生，也未能取得理想的结果，这让我们开始思考狭窄的病因是否决定了治疗结果。我们评估了这种“因果”关系，强调了病因对尿道狭窄整体预后的重要性。
在十年的时间里，我们对 302 名男性尿道狭窄患者（回顾性和前瞻性）进行了评估。术前评估通过逆行尿道造影、尿道超声和尿流率进行，并根据病因进行分类：a）创伤后，b）感染后，c）医源性，或 d）原因不明。创伤性狭窄患者进行骨盆 X 线检查，并根据 TILE 分类进一步分为 A、B 和 C 级。患者接受手术治疗；前尿道狭窄采用白膜尿道成形术，后尿道狭窄采用 U 形前列腺-球部吻合术。
创伤性狭窄占病例的 54%。302 例患者中，127 例采用白膜尿道成形术治疗，其余患者采用 U 形前列腺-球部吻合术。外伤性狭窄的治疗效果最好，而感染性狭窄的治疗效果最差。在骨盆骨折引起的狭窄中，TILE A 级和 B 级的术后过程优于 TILE C 级。总的并发症发生率为 13.24%。
我们的研究表明，尿道狭窄的病因可能对尿道狭窄的整体预后起着至关重要的作用。
