Jain Sudhir Kumar, Kaza Ram Chandra Murthy, Singh Bipin Kumar
Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
Urol Ann. 2014 Oct;6(4):328-33. doi: 10.4103/0974-7796.140997.
SACHSE COLD KNIFE IS CONVENTIONALLY USED FOR OPTICAL INTERNAL URETHROTOMY INTENDED TO MANAGE URETHRAL STRICTURES AND HO: YAG laser is an alternative to it. The aim of this study was to evaluate the role of urethral stricture treatment outcomes, efficacy, and complications using cold knife and Ho: YAG (Holmium laser) for optical internal urethrotomy.
In this prospective study included, 90 male patients age >18 years, with diagnosis of urethral stricture admitted for internal optical urethrotomy during April 2010 to March 2012. The patients were randomized into two groups containing 45 patients each using computer generated random number. In group A (Holmium group), internal urethrotomy was done with Holmium laser and in group B (Cold knife group) Sachse cold knife was used. Patients were followed up for 6 months after surgery in Out Patient Department on 15, 30 and 180 post-operative days. At each follow up visit physical examination, and uroflowmetry was performed along with noting complaints, if any.
The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for Holmium and Cold knife group was statistically highly significant (P < 0.001). Complications were seen in 12.22% of cases.
Both modalities are effective in providing immediate relief to patients with single and short segment (<2 cm long) urethral strictures but more sustained response was attained with Cold knife urethrotomy.
Sachse冷刀传统上用于光学尿道内切开术以治疗尿道狭窄,钬激光是其替代方法。本研究的目的是评估使用冷刀和钬激光(钬:钇铝石榴石激光)进行光学尿道内切开术对尿道狭窄治疗结果、疗效及并发症的作用。
本前瞻性研究纳入了90例年龄大于18岁、诊断为尿道狭窄并于2010年4月至2012年3月入院接受光学尿道内切开术的男性患者。使用计算机生成随机数将患者随机分为两组,每组45例。A组(钬激光组)采用钬激光进行尿道内切开术,B组(冷刀组)使用Sachse冷刀。患者术后在门诊于术后第15、30和180天进行6个月的随访。每次随访时进行体格检查、尿流率测定,并记录有无不适主诉。
每次随访时比较两组的最大尿流率(PFR)。在180天(6个月间隔)时,钬激光组和冷刀组PFR平均值之间的差异具有高度统计学意义(P < 0.001)。12.22%的病例出现并发症。
两种方法对单一且短节段(<2 cm长)尿道狭窄患者均可立即缓解症状,但冷刀尿道内切开术可获得更持久的疗效。