Bayne David B, Gaither Thomas W, Awad Mohannad A, Murphy Gregory P, Osterberg E Charles, Breyer Benjamin N
Department of Urology, University of California, San Francisco, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
Transl Androl Urol. 2017 Apr;6(2):288-294. doi: 10.21037/tau.2017.03.55.
Our objective is to report a comparative review of recently released guidelines for the evaluation, management, and follow-up of urethral stricture disease.
This is an analysis of the American Urologic Association (AUA) and Société Internationale d'Urologie (SIU) guidelines on urethral stricture. Strength of recommendations is stratified according to letter grade that corresponds to the level of evidence provided by the literature.
Although few, the discrepancies between the recommendations offered by the two guidelines can be best explained by varying interpretations of the literature and available evidence on urethral strictures. When comparing the AUA guidelines and the SIU guidelines on urethral stricture, there are very few discrepancies. Perhaps the most notable difference is in the use of repeat DVIU or urethral dilation after an initial failed attempt. SIU guidelines state that there are instances where repeat DVIU or urethral dilation can be indicated, and they give a range of time at which stricture recurrence post procedure mandates an urethroplasty (less than 3 to 6 months). The AUA guidelines definitively state that repeat endoscopic procedures should not be offered as an alternative to urethroplasty, and they do not mention time of stricture recurrence as a factor. SIU guidelines allow for management of urethral stricture with indwelling urethral stenting.
Overall there is a need for more high quality research in the work up, management, and follow up care of urethral stricture.
我们的目的是报告对最近发布的尿道狭窄疾病评估、管理及随访指南的比较性综述。
这是一项对美国泌尿外科学会（AUA）和国际泌尿外科学会（SIU）尿道狭窄指南的分析。推荐强度根据与文献提供的证据水平相对应的字母等级进行分层。
尽管两份指南的推荐意见差异不多，但可以通过对尿道狭窄文献和现有证据的不同解读来最好地解释这些差异。在比较AUA和SIU的尿道狭窄指南时，差异非常少。或许最显著的差异在于初次尝试失败后重复进行尿道内切开术（DVIU）或尿道扩张术的应用。SIU指南指出，在某些情况下可以进行重复DVIU或尿道扩张术，并且给出了术后狭窄复发需要进行尿道成形术的时间范围（小于3至6个月）。AUA指南明确指出，不应将重复内镜手术作为尿道成形术的替代方法，并且未提及狭窄复发时间这一因素。SIU指南允许采用留置尿道支架治疗尿道狭窄。
总体而言，在尿道狭窄的检查、管理及后续护理方面，需要开展更多高质量的研究。
