Neheman Amos, Rappaport Yishai H, Darawsha Abd E, Leibovitch Ilan, Sternberg Itay A
Urology Department, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Israel.
Urology Department, Assaf Harofeh Medical Center, Zerifin, affiliated to Sackler School of Medicine, Tel Aviv University, Israel.
Urology. 2019 Mar;125:191-195. doi: 10.1016/j.urology.2018.12.005. Epub 2018 Dec 12.
To assess uroflowmetry in the long-term follow-up of symptomatic meatal stenosis patients prior to and following meatotomy. Severity of symptoms and treatment success has been defined by patient history, physical examination, and witnessed voiding. Uroflowmetry might add objective parameters for the assessment, however long-term data are lacking.
A prospective study following 25 symptomatic toilet-trained boys before and after meatotomy was performed with short and long-term follow-up after surgery. Patient history, physical examination, and uroflowmetry variables were recorded.
Fifteen patients were fully evaluable. Mean age at operation was 6.4 years (2.5-10.5) with an average follow-up of 43 months. All patients were symptomatic before surgery; complete symptomatic resolution was achieved in all patients at short-term follow-up, and in 12 at long-term follow-up. A stenotic meatus was seen in all patients before surgery, at long-term follow-up 12 of 15 (80%) had an open appearing meatus (P = .0001). Abnormal uroflowmetry pattern was present in 8 of 15 (53%) prior to surgery and 2 of 15 (13%) at long-term follow-up (P = .02). Normal maximal flow rate as defined by ICCS were seen in 5, 11, and 12 patients before, 1 month after and at long-term follow-up (P = .06 and 0.02, respectively). PVR improved significantly at long-term follow-up (P = .0012).
Symptom evaluation and physical examination should be the hallmark assessing children with meatal stenosis. Clinical assessment one month after surgery suffices and long-term follow-up is unnecessary. Uroflowmetry provides objective assessment as well as surgical success; however, it is unnecessary since it does not change the management.
评估尿道口切开术前及术后有症状的尿道口狭窄患者长期随访中的尿流率。症状的严重程度和治疗效果通过患者病史、体格检查及观察排尿来确定。尿流率可能会为评估增加客观参数，但长期数据尚缺乏。
对25名有症状且已接受如厕训练的男孩在尿道口切开术前及术后进行前瞻性研究，并在术后进行短期和长期随访。记录患者病史、体格检查及尿流率变量。
15名患者可进行全面评估。手术时的平均年龄为6.4岁（2.5 - 10.5岁），平均随访43个月。所有患者术前均有症状；短期随访时所有患者症状完全缓解，长期随访时有12名患者症状完全缓解。术前所有患者均可见尿道口狭窄，长期随访时15名患者中有12名（80%）尿道口外观正常（P = 0.0001）。术前15名患者中有8名（53%）尿流率模式异常，长期随访时15名患者中有2名（13%）尿流率模式异常（P = 0.02）。根据国际儿童尿控协会（ICCS）定义，术前、术后1个月及长期随访时分别有5名、11名和12名患者最大尿流率正常（P分别为0.06和0.02）。长期随访时残余尿量（PVR）显著改善（P = 0.0012）。
症状评估和体格检查应是评估尿道口狭窄患儿的关键。术后1个月的临床评估就足够了，无需长期随访。尿流率可提供客观评估及手术效果评估；然而，由于它不改变治疗管理，所以没有必要进行。
