Yoon Cheol Yong, Chae Ji Yun, Kim Jong Wook, Kim Jin Wook, Oh Mi Mi, Park Hong Seok, Moon Du Geon, Cheon Jun, Lee Jeong Gu, Kim Jae Jong
Department of Urology and Center of Regenerative Medicine, College of Medicine, Korea University, Seoul, Korea.
Int Braz J Urol. 2014 Jul-Aug;40(4):576-7. doi: 10.1590/S1677-5538.IBJU.2014.04.20.
Fibrotic scar formation is a main cause of recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU). In the present study, we devised a new technique of combined the transurethral resection of fibrotic scar tissue and temporary urethral stenting, using a thermo-expandable urethral stent (Memokath(TM) 044TW) in patients with anterior urethral stricture.
As a first step, multiple incisions were made around stricture site with cold-utting knife and Collins knife electrode to release a stricture band. Fibrotic tissue was then resected with a 13Fr pediatric resectoscope before deployment of a MemokathTM 044TW stent (40 - 60mm) on a pre-mounted sheath using 0° cystoscopy. Stents were removed within12 months after initial placement.
We performed this technique on 11 consecutive patients with initial (n = 4) and recurrent (n = 7) anterior urethral stricture (April 2009 – February 2013). At 18.9 months of mean follow-up (12-34 months), mean Qmax (7.8±3.9ml/sec vs 16.8 ± 4.8ml/sec, p < 0.001), IPSS (20.7 vs 12.5, p = 0.001 ), and QoL score (4.7 vs 2.2, p < 0.001) were significantly improved. There were no significant procedure-related complications except two cases of tissue ingrowth at the edge of stent, which were amenable by transurethral resection. In 7 patients, an average 1.4 times (1-5 times) of palliative urethral dilatation was carried out and no patients underwent open surgical urethroplasty during the follow-up period.
Combined transurethral resection and temporary urethral stenting is a effective therapeutic option for anterior urethral stricture. Further investigations to determine the long-term effects, and safety profile of this new technique are warranted.
在经直视下尿道内切开术（DVIU）进行初始治疗后，纤维化瘢痕形成是复发性尿道狭窄的主要原因。在本研究中，我们设计了一种新技术，即对前尿道狭窄患者联合经尿道切除纤维化瘢痕组织并进行临时尿道支架置入，使用热膨胀性尿道支架（Memokath™ 044TW）。
第一步，用冷切割刀和柯林斯刀电极在狭窄部位周围进行多处切开，以松解狭窄带。然后用13Fr小儿电切镜切除纤维化组织，之后使用0°膀胱镜将Memokath™ 044TW支架（40 - 60mm）置于预先安装的鞘管上。支架在初次置入后12个月内取出。
我们对11例连续性前尿道狭窄患者（初始狭窄4例，复发性狭窄7例）实施了该技术（2009年4月至2013年2月）。平均随访18.9个月（12 - 34个月）时，最大尿流率（Qmax）均值（7.8±3.9ml/秒对16.8±4.8ml/秒，p < 0.001）、国际前列腺症状评分（IPSS）（20.7对12.5，p = 0.001）和生活质量评分（QoL）（4.7对2.2，p < 0.001）均有显著改善。除2例支架边缘组织向内生长（可通过经尿道切除处理）外，无明显与手术相关的并发症。7例患者平均进行了1.4次（1 - 5次）姑息性尿道扩张，随访期间无患者接受开放性手术尿道成形术。
经尿道切除联合临时尿道支架置入是治疗前尿道狭窄的一种有效治疗选择。有必要进一步研究以确定该新技术的长期效果和安全性。
