Jhanwar Ankur, Kumar Manoj, Sankhwar Satya Narayan, Prakash Gaurav
King George's Medical University, Lucknow, India.
Can Urol Assoc J. 2016 May-Jun;10(5-6):E161-E164. doi: 10.5489/cuaj.3382. Epub 2016 May 12.
Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture.
We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months.
Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups.
Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.
我们的目标是分析钬激光与冷刀直视下内尿道切开术（DVIU）治疗短段球部尿道狭窄的疗效。
我们进行了一项前瞻性研究，纳入了2013年6月至2014年12月期间就诊的112例男性患者。纳入标准为短段球部尿道狭窄（≤1.5cm）。排除标准为既往有干预/尿道成形术史、全前尿道狭窄、后尿道狭窄、尿路感染以及失访患者。患者分为两组；A组（n=58）采用冷刀DVIU，B组（n=54）采用钬激光尿道内切开术。患者随访包括术后第3天、3个月和6个月的尿流率检查。
两组的基线人口统计学特征具有可比性。共有107例患者符合纳入标准，5例患者因随访不充分被排除。A组和B组的平均狭窄长度分别为1.31±0.252cm（p=0.53）和1.34±0.251cm。A组的平均手术时间为16.3±1.78分钟，B组为20.96±2.23分钟（p=0.0001）。A组有5例患者术后出血，通过会阴压迫保守治疗。B组有3例患者术后出现液体外渗。在所有随访中，两组之间的最大尿流率（ml/s）在统计学上无显著差异。
就疗效和并发症发生率而言，钬激光和冷刀尿道切开术在治疗短段球部尿道狭窄方面都是安全且同样有效的。然而，钬激光需要更多的专业知识，且是一种成本较高的选择。
