Hampson Lindsay A, McAninch Jack W, Breyer Benjamin N
Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA.
Nat Rev Urol. 2014 Jan;11(1):43-50. doi: 10.1038/nrurol.2013.275. Epub 2013 Dec 17.
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
男性尿道狭窄疾病较为常见,对生活质量和医疗费用有重大影响。尿道狭窄的治疗较为复杂,取决于狭窄的特征。数据显示,尿道扩张术和尿道内切开术在长期疗效方面并无差异;成功率差异很大,在8%至80%之间,长期成功率为20%至30%。对于这两种手术,狭窄较长、阴茎尿道狭窄、多处狭窄、存在感染或有既往手术史的男性复发风险更高。分析表明,在这些患者中反复使用尿道内切开术在临床和成本效益方面均不佳。尿道成形术进行手术重建的长期成功率更高,大多数研究表明成功率为85%至90%。根据狭窄的位置、长度和特征,已采用多种技术进行尿道成形术。成功治疗尿道狭窄需要详细了解解剖学、病理生理学、正确的患者选择和重建技术。