Yu Shi-Cheng, Wu Hai-Yang, Wang Wei, Xu Li-Wei, Ding Guo-Qing, Zhang Zhi-Gen, Li Gong-Hui
Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
J Zhejiang Univ Sci B. 2016 Sep;17(9):722-7. doi: 10.1631/jzus.B1600096.
We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation (HPBD) technique for anterior urethral stricture.
From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient demographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques.
The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min, P<0.01). For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection (UTI) were less frequently encountered than those in DVIU (urethral bleeding: 2/31 vs. 8/25, P=0.017; UTI: 1/31 vs. 6/25 P=0.037). The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups (P=0.21, hazard ratio (HR)=0.65, 95% confidence interval (CI): 0.34 to 1.26). However, there was a significantly higher stricture-free survival in the HPBD group at 12 months (P=0.02, HR=0.35, 95% CI: 0.14 to 0.87), which indicated that the stricture recurrence could be delayed by using the HPBD technique.
HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.
我们回顾性分析了在我们三级中心治疗的尿道狭窄病例,并评估了高压球囊扩张(HPBD)技术治疗前尿道狭窄的安全性和可行性。
2009年1月至2012年12月,共有31例前尿道狭窄患者在我们中心接受了HPBD治疗,另有25例采用直视下尿道内切开术(DVIU)治疗。评估并比较了两组患者的人口统计学资料、狭窄特征、手术技术和手术结果。采用Kaplan-Meier生存分析评估两种手术技术的无狭窄率。
HPBD手术的操作时间比DVIU短得多((13.19±2.68)分钟对(18.44±3.29)分钟,P<0.01)。对于HPBD组,术后主要并发症如尿道出血和尿路感染(UTI)的发生率低于DVIU组(尿道出血:2/31对8/25,P=0.017;UTI:1/31对6/25,P=0.037)。Kaplan-Meier生存分析显示,两组在36个月时的无狭窄率无显著差异(P=0.21,风险比(HR)=0.65,95%置信区间(CI):0.34至1.26)。然而,HPBD组在12个月时的无狭窄生存率显著更高(P=0.02,HR=0.35,95%CI:0.14至0.87),这表明使用HPBD技术可延迟狭窄复发。
HPBD有效且安全,可被视为前尿道狭窄疾病的一种替代治疗方式。