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[男性尿道狭窄的病因及治疗]

[Causes and management for male urethral stricture].

作者信息

Chen Caifang, Zeng Mingqiang, Xue Ruizhi, Wang Guilin, Gao Zhiyong, Yuan Wuxiong, Tang Zhengyan

机构信息

Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.

Department of Urology, Hunan Provincial People's Hospital; First Affi liated Hospital of Hunan Normal University, Changsha 410005; Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 May 28;43(5):520-527. doi: 10.11817/j.issn.1672-7347.2018.05.010.

Abstract

To explore the etiology of male urethral stricture, analyze the therapeutic strategies of urethral stricture, and summarize the complicated cases.
 Methods: The data of 183 patients with urethral stricture were retrospectively analyzed, including etiology, obstruction site, stricture length, therapeutic strategy, and related complications.
 Results: The mean age was 49.7 years, the average course was 64.7 months, and the constituent ratio of 51 to 65 years old patients was 38.8% (71/183). The traumatic injury of patients accounted for 52.4% (96/183), in which the pelvic fracture accounted for 35.5% (65/183) and the straddle injury accounted for 16.9% (31/183). There were 54 cases of iatrogenic injury (29.5%). The posterior urethral stricture accounted for 45.9% (84/183), followed by the anterior urethral stricture (44.8%, 82/183) and the stenosis (6.6%, 12/183). A total of 99 patients (54.1%) received the end to end anastomosis, and 40 (21.9%) were treated with intracavitary surgery, such as endoscopic holmium laser, cold knife incision, endoscopic electroknife scar removal, balloon dilation, and urethral dilation. In the patients over 65-years old, the urethral stricture rate was 14.8% and the complication rate (70.4%) for transurethral resection of the prostate (TURP) was significantly higher than that of all samples (P<0.01).
 Conclusion: Both the etiology of male urethral stricture and the treatment strategy have changed and the incidence of traumatic and iatrogenic urethral stricture has increased in recent 3 years. The main treatment of urethral stricture has been transformed from endoscopic surgery into urethroplasty.

摘要

探讨男性尿道狭窄的病因,分析尿道狭窄的治疗策略,并总结复杂病例。方法:回顾性分析183例尿道狭窄患者的数据,包括病因、梗阻部位、狭窄长度、治疗策略及相关并发症。结果:平均年龄49.7岁,平均病程64.7个月,51至65岁患者构成比为38.8%(71/183)。患者创伤性损伤占52.4%(96/183),其中骨盆骨折占35.5%(65/183),骑跨伤占16.9%(31/183)。医源性损伤54例(29.5%)。后尿道狭窄占45.9%(84/183),其次是前尿道狭窄(44.8%,82/183)和狭窄(6.6%,12/183)。共99例患者(54.1%)接受端端吻合术,40例(21.9%)接受腔内手术治疗,如内镜钬激光、冷刀切开、内镜电刀瘢痕切除、球囊扩张及尿道扩张。65岁以上患者尿道狭窄率为14.8%,经尿道前列腺电切术(TURP)并发症发生率(70.4%)显著高于所有样本(P<0.01)。结论:男性尿道狭窄的病因及治疗策略均发生了变化,近3年创伤性和医源性尿道狭窄的发生率有所增加。尿道狭窄的主要治疗方式已从内镜手术转变为尿道成形术。

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