Heyns C F, van der Merwe J, Basson J, van der Merwe A
Department of Urology, Stellenbosch University, Western Cape, South Africa.
S Afr J Surg. 2012 Jul 16;50(3):82-7. doi: 10.7196/sajs.1081.
To investigate the possible reasons for repeated urethral dilatation or optical internal urethrotomy rather than urethroplasty in the treatment of male urethral strictures.
Men referred to the stricture clinic of our institution during the period April 2007 - March 2008 were reviewed and the operative urological procedures performed in the same period were analysed. Statistical analysis was performed using Student's t-test and Fisher's exact test (p<0.05 statistically significant).
The mean age of the 125 men was 49.9 years (range 12.8 - 93.4 years). Previous stricture treatment had been given 1 - 2, 3 - 4 and 5 - 6 times in 52%, 32% and 12% of patients, respectively (4% had not undergone treatment). In these groups, previous treatment was dilatation in 70%, 76% and 72%, urethrotomy in 26%, 15% and 28%, and urethroplasty in 4%, 9% and 0, respectively. The group with 5 - 6 compared with 1 - 2 previous treatments was significantly older (mean age 60.2 v. 46.6 years) and had a significantly greater proportion with underlying co-morbidities (80% v. 52%). The group that had undergone urethroplasty compared with 5 - 6 repeated dilatations or urethrotomies was significantly younger (mean age 48.2 v. 60.2 years) with a lower prevalence of co-morbidities (47% v. 80%). During the study period urethroplasty was performed in 16 (2%) of 821 inpatients, whereas 55 men were seen who had undergone ≥3 previous procedures, indicating that urethroplasty was performed in less than one-third of cases in which it would have been the optimal treatment. Owing to limited theatre time, procedures indicated for malignancy, urolithiasis, renal failure and congenital anomalies were performed more often than urethroplasty.
Factors that possibly influenced the decision to perform repeated urethrotomy or dilatation instead of urethroplasty were limited theatre time, increased patient age and the presence of underlying co-morbidities.
探讨在男性尿道狭窄治疗中，反复进行尿道扩张或内镜下尿道内切开术而非尿道成形术的可能原因。
回顾2007年4月至2008年3月期间转诊至我院狭窄门诊的男性患者，并分析同期所施行的泌尿外科手术。采用学生t检验和Fisher精确检验进行统计学分析（p<0.05具有统计学意义）。
125名男性患者的平均年龄为49.9岁（范围12.8 - 93.4岁）。分别有52%、32%和12%的患者曾接受过1 - 2次、3 - 4次和5 - 6次既往狭窄治疗（4%未接受过治疗）。在这些组中，既往治疗为扩张的分别占70%、76%和72%，尿道内切开术的分别占26%、15%和28%，尿道成形术的分别占4%、9%和0。与接受过1 - 2次既往治疗的组相比，接受过5 - 6次既往治疗的组年龄显著更大（平均年龄60.2岁对46.6岁），且合并基础疾病的比例显著更高（80%对52%）。与接受5 - 6次反复扩张或尿道内切开术的组相比，接受过尿道成形术的组年龄显著更小（平均年龄48.2岁对60.2岁），合并疾病的患病率更低（47%对80%）。在研究期间，821名住院患者中有16名（2%）接受了尿道成形术，而有55名男性患者曾接受过≥3次既往手术，这表明在本应是最佳治疗方法的病例中，接受尿道成形术的患者不到三分之一。由于手术时间有限，针对恶性肿瘤、尿路结石、肾衰竭和先天性异常的手术比尿道成形术更常进行。
可能影响决定进行反复尿道内切开术或扩张而非尿道成形术的因素包括手术时间有限、患者年龄增加以及合并基础疾病。
