Department of Urology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle upon Tyne, UK.
Curr Opin Urol. 2012 Nov;22(6):467-73. doi: 10.1097/MOU.0b013e32835621a2.
Urethral dilatation and direct visual internal urethrotomy (DVIU) are widely used minimally invasive options to manage men with urethral strictures. Advances in open urethroplasty with better long-term cure rates have fuelled the continuing debate as to which treatment is best for primary and recurrent urethral strictures. We reviewed recent literature to identify contemporary practice of urethral dilatation and DVIU and the long-term outcome of these procedures.
Systematic literature search for the period January 2010 to December 2011 showed that urethral dilatation and DVIU remain frequently used treatment options as confirmed by surveys of urologists in the USA and the Netherlands. Multiple reports of laser DVIU confirm the safety of this approach but long-term data were lacking. Stricture free rates from urethra dilatation and DVIU vary from 10 to 90% at 12 months, although adjunctive intermittent self-dilatation can reduce time to recurrence. Although quality-of-life benefit appears good in the short term, repeated procedures may harm sexual function in the long-term.
Urethral dilatation and DVIU remain widely used in urethral stricture management but high-level comparative evidence of benefit and harms against urethroplasty in the short and long-term is still lacking.
目的综述：尿道扩张和直接可视尿道内切开术（DVIU）是广泛应用的微创治疗选择，适用于治疗尿道狭窄的男性患者。开放式尿道成形术的进步带来了更好的长期治愈率，这加剧了关于哪种治疗方法对原发性和复发性尿道狭窄最有效的持续争论。我们对近期文献进行了综述，以确定尿道扩张和 DVIU 的最新应用实践，以及这些方法的长期结果。
最新发现：2010 年 1 月至 2011 年 12 月的系统文献检索显示，尿道扩张和 DVIU 仍然是美国和荷兰泌尿科医生调查确认的常用治疗选择。激光 DVIU 的多项报告证实了这种方法的安全性，但缺乏长期数据。尿道扩张和 DVIU 的无狭窄率在 12 个月时从 10%到 90%不等，尽管辅助间歇性自我扩张可以减少复发时间。尽管短期来看，生活质量的改善似乎较好，但长期反复的治疗可能会损害性功能。
总结：尿道扩张和 DVIU 仍然广泛应用于尿道狭窄的治疗，但在短期和长期内，与尿道成形术相比，仍缺乏关于其疗效和危害的高级别比较证据。
