Isono Makoto, Horiguchi Akio, Tasaki Shinsuke, Kuroda Kenji, Sato Akinori, Asakuma Junichi, Seguchi Kenji, Ito Keiichi, Hayakawa Masamichi, Asano Tomohiko
Department of Urology, National Defense Medical College, Saitama, Japan.
Nihon Hinyokika Gakkai Zasshi. 2012 Nov;103(6):691-6. doi: 10.5980/jpnjurol.103.691.
Direct vision internal urethrotomy (DVIU) has been considered to be a low invasive and widely used therapeutic modality for male urethral stricture. However, its efficacy is still controversial. We herein evaluated the efficacy of DVIU for male urethral stricture.
Nineteen patients 27 to 78 years old (median age = 59) underwent DVIU for urethral strictures at our hospital were included in this study. Strictures were at bulbar urethra in 17 patients, membranous urethra in 1 patient, and pendulous urethra in 1 patient. The stricture lengths estimated on retrograde urethrography were less than 1 cm in 13 patients, 1-2 cm in 2 patients, and more than 2 cm in 4 patients. The etiology of stricture was straddle injury in 7 patients, post transurethral surgery in 7 patients, pelvic fracture in 1 patient, and unknown in 4 patients. The operation was done by cold knife incision using guidewire. The duration of postoperative urethral catheterization was 5 to 35 days (mean 12.8 days). Follow up duration ranged from 1 month to 139 months (mean 48.2 months). The definition of postoperative re-stricture was the confirmation of re-stricture on retrograde urethrography or deterioration of symptom.
While no severe complication was observed, postoperative re-stricture was seen in 13 patients. Stricture-free rates at 3 months, 6 months, and 5 years after the first DVIU were 44.4%, 38.1%, 20.3% respectively. Although second DVIU was done for 7 patients with re-stricture, six patients resulted in failure. Stricture-free rates at 3 months, 6 months, and 5 years after the second DVIU were 42.2%, 28.6%, 14.3% respectively. Though the third DVIU was done for two of them, they were unable to void just immediately after the removal of urethral catheters. Stricture-free rate in stricture less than 1 cm was higher than that in 1 cm or longer, though it did not reach significant difference (p = 0.1813).
The efficacy of DVIU is lesser than we expected. DVIU seems to be excessively applied to male urethral strictures and should not be performed for long and recurrent urethral stricture.
直视下尿道内切开术（DVIU）被认为是治疗男性尿道狭窄的一种微创且广泛应用的治疗方式。然而，其疗效仍存在争议。我们在此评估DVIU治疗男性尿道狭窄的疗效。
本研究纳入了我院19例年龄在27至78岁（中位年龄=59岁）因尿道狭窄接受DVIU治疗的患者。17例患者的狭窄位于球部尿道，1例位于膜部尿道，1例位于悬垂部尿道。逆行尿道造影估计的狭窄长度，13例患者小于1cm，2例患者为1 - 2cm，4例患者大于2cm。狭窄病因包括骑跨伤7例，经尿道手术后7例，骨盆骨折1例，4例病因不明。手术采用导丝引导下冷刀切开。术后尿道留置导尿管时间为5至35天（平均12.8天）。随访时间为1个月至139个月（平均48.2个月）。术后再狭窄的定义为逆行尿道造影证实再狭窄或症状恶化。
未观察到严重并发症，但13例患者出现术后再狭窄。首次DVIU后3个月、6个月和5年的无狭窄率分别为44.4%、38.1%、20.3%。7例再狭窄患者接受了二次DVIU，但6例失败。二次DVIU后3个月、6个月和5年的无狭窄率分别为42.2%、28.6%、14.3%。其中2例患者接受了三次DVIU，但拔除尿道导管后立即无法排尿。狭窄小于1cm的患者无狭窄率高于1cm及以上者，虽未达到显著差异（p = 0.1813）。
DVIU的疗效低于我们的预期。DVIU似乎在男性尿道狭窄治疗中应用过度，对于长段及复发性尿道狭窄不应采用。
