Yürük Emrah, Yentur Serhat, Çakır Ömer Onur, Ertaş Kasım, Şerefoğlu Ege Can, Semerciöz Atilla
Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey.
Turk J Urol. 2016 Sep;42(3):184-9. doi: 10.5152/tud.2016.90490.
Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU.
Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukey's test and Pearson's correlation test, respectively.
Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004).
Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.
冷刀直视下内尿道切开术（DVIU）常被用作尿道狭窄疾病的一线治疗方法。尽管该手术步骤有详细定义，但术后导尿时间及所用导尿管的直径尚无明确界定。本研究旨在评估导尿管留置时间和直径对DVIU术后尿道狭窄疾病复发率的影响。
回顾性分析2009年1月至2013年6月期间连续193例初次接受DVIU治疗的球部尿道狭窄患者的数据。记录患者人口统计学资料和狭窄特征。导尿管留置时间分为<5天和≥5天两组。所用导尿管直径为16、18和22F。分别采用Tukey检验和Pearson相关检验评估复发率、导尿管留置时间和直径之间的关联。
本研究共纳入193例患者，平均年龄64.51±12.99（范围：17至85）岁。45例（23.31%）患者在DVIU术后第一年内出现尿道狭窄疾病复发。复发患者和未复发患者的平均导尿时间分别为7.47±4.03天和4.79±1.94天（p=0.0001）。导尿管留置时间≥5天也与复发率增加相关（p=0.0001）。在复发狭窄的患者中，分别有22.22%、20%和57.78%的患者使用了16F、18F和22F的导尿管。导尿管直径增加也与较高的复发率相关（p=0.004）。
缩短术后导尿时间并减小导尿管尺寸可能会降低DVIU术后的复发率。需要进一步进行前瞻性随机试验来证实这些发现。
