Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China .
J Endourol. 2014 May;28(5):502-8. doi: 10.1089/end.2013.0538. Epub 2014 Jan 31.
Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. This review was performed to determine the best strategy for stricture recurrence prevention following urethral endoscopic management.
We reviewed the published literature in PubMed, the Cochrane Library, and Google Scholar focusing on this intractable problem regardless of language restrictions. Outcomes of interest included the study methods and the applied strategy's efficacy. The level of evidence and grade of recommendations of included studies were appraised with an Oxford Centre for Evidence-Based Medicine Scale.
Currently, numerous techniques, including catheterization, repeated dilation, brachytherapy, and intraurethral use of various antifibrosis agents, have been employed to oppose the process of wound contraction or regulate the extracellular matrix. But unfortunately, none of these techniques or agents have demonstrated efficacy with enough evidence.
Although lots of strategies are available, still, we do not have a suitable, single optimum solution for all the conditions. The clinical decision of stricture-recurrence-prevention techniques should be carefully tailored to every individual patient. As the studies are not sufficient, more efforts are warranted to address this interesting but challenging issue.
尿道狭窄是年轻男性排尿困难的最常见原因，初始治疗后常有复发。本综述旨在确定尿道内镜治疗后预防狭窄复发的最佳策略。
我们检索了 PubMed、Cochrane 图书馆和 Google Scholar 中发表的文献，无论语言限制如何，都聚焦于这一棘手问题。主要结局指标包括研究方法和应用策略的疗效。我们使用牛津循证医学中心的评价标准评估了纳入研究的证据水平和推荐等级。
目前，已经采用了多种技术来对抗创伤收缩或调节细胞外基质的过程，包括导尿、反复扩张、近距离放疗和尿道内应用各种抗纤维化药物。但遗憾的是，这些技术或药物都没有足够的证据证明其疗效。
尽管有很多策略可用，但我们仍然没有一种适用于所有情况的单一最佳解决方案。预防狭窄复发的技术的临床决策应根据每个患者的具体情况仔细制定。由于研究还不够充分，需要进一步努力来解决这个有趣但具有挑战性的问题。
