Departments of Urology and Plastic Surgery (RA), National Defense Medical College, Tokorozawa, Japan.
Departments of Urology and Plastic Surgery (RA), National Defense Medical College, Tokorozawa, Japan.
J Urol. 2018 Feb;199(2):508-514. doi: 10.1016/j.juro.2017.08.100. Epub 2017 Sep 1.
We examined the impact on urethral stricture complexity at urethroplasty of previous transurethral treatments such as dilation, urethrotomy and stenting, which are most commonly performed when treating male urethral stricture.
We retrospectively reviewed the records of 45 males who had undergone transurethral treatments before urethroplasty. We compared urethrography findings at initial diagnosis with those at urethroplasty. Males with failed hypospadias repair, lichen sclerosis or a history of prior urethroplasty were excluded from analysis. We considered stricture complexity increased if the number and/or length of strictures on urethrography at urethroplasty was greater than that at initial diagnosis or false passage was newly identified.
Of the patients 39 (87%), 32 (71%) and 13 (29%) had undergone urethral dilation, urethrotomy and urethral stenting, respectively, and 39 (87%) had undergone repeat or multiple kinds of transurethral treatments. Stricture complexity was increased in 22 men (49%) while 7 (16%) required urethroplasty more complex than that anticipated from urethrography findings at initial diagnosis. Increased stricture complexity was significantly associated with a history of urethrotomy (p = 0.03), urethral stenting (p = 0.0002) and repeat transurethral treatments (p = 0.01). Multivariate analysis revealed that urethral stenting (p = 0.01) and repeat transurethral treatments (p = 0.01) were independent predictors of increased stricture complexity.
Repeat transurethral treatments increase stricture complexity and are potentially counterproductive. Even a single application of temporary urethral stenting carries a high risk of complicating the stricture and requiring complex urethroplasty.
我们研究了尿道扩张、尿道切开术和支架置入术等经尿道治疗对尿道狭窄复杂性的影响，这些治疗方法在治疗男性尿道狭窄时最常采用。
我们回顾性分析了 45 例男性患者的病历资料，这些患者在尿道成形术前均接受过经尿道治疗。我们比较了初次诊断时的尿道造影结果和尿道成形术时的结果。患有失败的尿道下裂修复、硬化性苔藓或既往尿道成形术病史的患者被排除在分析之外。如果尿道成形术时的尿道造影上的狭窄数量和/或长度比初次诊断时增加，或者发现新的假道，则认为狭窄复杂性增加。
39 例（87%）、32 例（71%）和 13 例（29%）患者分别接受了尿道扩张、尿道切开术和尿道支架置入术，39 例（87%）患者接受了重复或多种经尿道治疗。22 例（49%）患者的狭窄复杂性增加，7 例（16%）患者需要比初次诊断时的尿道造影结果预计更复杂的尿道成形术。尿道切开术史（p=0.03）、尿道支架置入术史（p=0.0002）和重复经尿道治疗史（p=0.01）与狭窄复杂性增加显著相关。多变量分析显示，尿道支架置入术（p=0.01）和重复经尿道治疗（p=0.01）是狭窄复杂性增加的独立预测因素。
重复经尿道治疗会增加狭窄复杂性，并且可能适得其反。即使单次应用临时尿道支架也会增加使狭窄复杂化并需要复杂尿道成形术的风险。
