El Darawany H M
FRCSI Urology, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Department of Urology, Khobar, Saudi Arabia.
Prog Urol. 2017 Sep;27(11):594-599. doi: 10.1016/j.purol.2017.06.006. Epub 2017 Jul 26.
To detect the optimal time for urethral stent removal after endoscopic urethral realignment and its effect on the incidence of development of urethral stricture.
Eighteen patients underwent endoscopic urethral realignment after traumatic disruption of the posterior urethra. Post-operative urethroscopy was done using the flexible cystoscope to assess progress of urethral healing. The urethral Foley catheter that served as a stent and for urine drainage was removed only when complete mucosal healing was observed by flexible urethroscopy. There was a post-operative follow-up period of 12-36months. Uroflowmetry was performed at the end of the follow-up period.
Endoscopy 6weeks after realignment showed 50-75% mucosal epithelialization at the site of urethral disruption in all patients. Epithelialization was complete at 9weeks in 15/18 patients (83%) and at 12weeks in the remaining 3 patients (17%). One patient (5.6%) developed a mild symptomatic stricture 5months post stent removal that was successfully treated by a single session of visual urethrotomy. All 18 patients had normal uroflowmetry readings at 12-36months after realignment.
Urethral stenting should be continued till mucosal healing at the site of urethral disruption became complete. Removal of the stent at this optimal time decreases the incidence of post-operative urethral stricture. Flexible urethroscopy was a safe procedure for post-operative follow-up of endoscopic urethral realignment to assess the progress and completion of mucosal healing at the site of realignment.
检测内镜下尿道会师术后尿道支架取出的最佳时间及其对尿道狭窄发生率的影响。
18例患者因后尿道创伤性断裂接受了内镜下尿道会师术。术后使用软性膀胱镜进行尿道镜检查以评估尿道愈合进程。仅当软性尿道镜检查观察到黏膜完全愈合时，才取出作为支架及用于尿液引流的尿道Foley导尿管。术后随访期为12 - 36个月。随访期末进行尿流率测定。
会师术后6周的内镜检查显示，所有患者尿道断裂部位黏膜上皮化程度为50% - 75%。15/18例患者（83%）在9周时上皮化完成，其余3例患者（17%）在12周时上皮化完成。1例患者（5.6%）在支架取出后5个月出现轻度症状性狭窄，经单次直视下尿道内切开术成功治疗。所有18例患者在会师术后12 - 36个月尿流率读数均正常。
尿道支架应持续留置直至尿道断裂部位黏膜愈合完全。在此最佳时间取出支架可降低术后尿道狭窄的发生率。软性尿道镜检查是内镜下尿道会师术后随访的安全方法，可评估会师部位黏膜愈合的进程及完成情况。
4级。
