Deng Tuo, Liao Banghua, Luo Deyi, Liu Bing, Wang Kunjie, Liu Jiaming, Jin Tao
Department of Urology, West China Hospital, Sichuan University Chengdu 610041, P.R. China.
Department of Ophthalmology, West China Hospital, Sichuan University Chengdu 610041, P.R. China.
Int J Clin Exp Med. 2015 Mar 15;8(3):3912-23. eCollection 2015.
Therapy for anterior combined with posterior urethral stricture is difficult and controversial. This study aims to introduce a standard process for managing anterior combined with posterior urethral stricture.
19 patients with anterior combined with posterior urethral stricture were treated following our standard process. Average (range) age was 52 (21-72) years old. In this standard process, anterior urethral stricture should be treated first. Endoscopic surgery is applied for anterior urethra stricture as a priority as long as obliteration does not occur, and operation for posterior urethral stricture can be conducted in the same stage. Otherwise, an open reconstructive urethroplasty for anterior urethral is needed; while in this condition, the unobliterated posterior urethra can also be treated with endoscopic surgery in the same stage; however, if posterior urethra obliteration exists, then open reconstructive urethroplasty for posterior urethral stricture should be applied 2-3 months later.
The median (range) follow-up time was 25.8 (3-56) months. All 19 patients were normal in urethrography after 1 month of the surgery. 4 patients (21.1%) recurred urethral stricture during follow-up, and the locations of recurred stricture were bulbomembranous urethra (2 cases), bulbar urethra (1 case) and bladder neck (1 case). 3 of them restored to health through urethral dilation, yet 1 underwent a second operation. 2 patients (10.5%) complaint of dripping urination. No one had painful erection, stress urinary incontinence or other complications.
The management for anterior combined with posterior urethral stricture following our standard process is effective and safe.
前尿道与后尿道联合狭窄的治疗困难且存在争议。本研究旨在介绍一种处理前尿道与后尿道联合狭窄的标准流程。
19例前尿道与后尿道联合狭窄患者按照我们的标准流程进行治疗。平均（范围）年龄为52（21 - 72）岁。在该标准流程中，应先处理前尿道狭窄。只要未发生闭锁，优先采用内镜手术治疗前尿道狭窄，后尿道狭窄可在同一阶段进行手术。否则，需要对前尿道进行开放性重建尿道成形术；在此情况下，未闭锁的后尿道也可在同一阶段采用内镜手术治疗；然而，如果存在后尿道闭锁，则应在2 - 3个月后对后尿道狭窄进行开放性重建尿道成形术。
中位（范围）随访时间为25.8（3 - 56）个月。所有19例患者术后1个月尿道造影均正常。4例患者（21.1%）在随访期间出现尿道狭窄复发，复发狭窄部位为球膜部尿道（2例）、球部尿道（1例）和膀胱颈（1例）。其中3例通过尿道扩张恢复健康，1例接受了二次手术。2例患者（10.5%）主诉尿滴沥。无患者出现阴茎勃起疼痛、压力性尿失禁或其他并发症。
按照我们的标准流程处理前尿道与后尿道联合狭窄有效且安全。
