Kotov S V, Belomyttsev S V, Guspanov R I, Semenov M K, Iritsyan M M, Ugurchiev A M
N.I. Pirogov RNRMU of Minzdrav of Russia, Department of Urology and Andrology, Moscow, Russia.
N.I. Pirogov City Clinical Hospital 1, Moscow Health Department, Moscow, Russia.
Urologiia. 2018 Oct(4):56-63.
Iatrogenic urethral damage is the leading etiologic factor for urethral stricture in men in developed countries and second after traumatic injury in developing ones. This study aimed to evaluate the frequency of iatrogenic strictures of the urethra and the results of their treatment.
This retrospective analysis comprised 133 patients who were treated for iatrogenic urethral stricture from 2011to 2016. Group I included 72 (54%) patients after trans(intra)urethral interventions (transurethral resection of the prostate or urinary bladder), urethral dilation, traumatic catheterization, etc. Forty-five (34%) patients with post-catheter strictures (ischemic/post-inflammatory), 7 (5%) patients after failed treatment of hypospadias, and 9 (7%) patients after open adenomectomy made up groups II, III, and IV. The diagnosis of recurrent stricture and the need for repeat surgical intervention were determined based on uroflowmetry, urethrography, and urethrocystoscopy.
In group I, the mean extent (rank) of the stricture was 2 (0.1-15) cm, the most frequent location (85%) was the bulbar urethra. In group II, the most frequent location (71%) was also the bulbar urethra with a mean stricture length of 2.4 (0.3-13) cm. There were 4 cases of panurethral strictures, lesions of the penile urethra and meatal stenosis. In group III, the strictures were on average 6 (2-12) cm long. Patients group IV had strictures of the bulbar and prostatic urethra. In general, the effectiveness of endoscopic treatment (direct vision internal urethrotomy, DVIU) was 52%, the effectiveness of urethroplasty varied from 83 to 100% depending on the method. In group I, the effectiveness of the DVIU was 52%, various types of urethroplasty - 88-100%, in group II - 50% and 82-100%, respectively. In group III, the effectiveness of the single-stage/multi-stage buccal mucosa urethroplasty was estimated at 0%/100%. In group IV, the effectiveness of DVIU/urethroplasty/perineal prostatectomy was 20%/75%/100%.
The proportion of iatrogenic urethral strictures in large megacities can reach 45%. Iatrogenic urethral strictures most commonly result from catheterization and transurethral interventions. Each subgroup of iatrogenic strictures is characterized by its location, extent and degree of urethral spongiofibrosis. With the correct choice of surgical modality, urethroplasty is almost twice more effective than DVIU.
在发达国家，医源性尿道损伤是男性尿道狭窄的主要病因，而在发展中国家则仅次于创伤性损伤，位居第二。本研究旨在评估医源性尿道狭窄的发生率及其治疗效果。
本回顾性分析纳入了2011年至2016年期间接受医源性尿道狭窄治疗的133例患者。第一组包括72例（54%）经尿道（经尿道前列腺切除术或膀胱切除术）、尿道扩张、创伤性导尿等干预后的患者。第二组、第三组和第四组分别为45例（34%）导尿管相关性狭窄（缺血性/炎症后）患者、7例（5%）尿道下裂治疗失败患者以及9例（7%）开放性腺瘤切除术后患者。根据尿流率测定、尿道造影和尿道膀胱镜检查确定复发性狭窄的诊断以及再次手术干预的必要性。
在第一组中，狭窄的平均范围（等级）为2（0.1 - 15）cm，最常见的部位（85%）是球部尿道。在第二组中，最常见的部位（71%）也是球部尿道，平均狭窄长度为2.4（0.3 - 13）cm。有4例全尿道狭窄、阴茎尿道病变和尿道口狭窄。在第三组中，狭窄平均长度为6（2 - 1）cm。第四组患者的球部和前列腺尿道有狭窄。总体而言，内镜治疗（直视下内尿道切开术，DVIU）的有效率为52%，尿道成形术的有效率根据方法不同在83%至%之间。在第一组中，DVIU的有效率为52%，各种类型的尿道成形术有效率为88% - 100%；在第二组中，分别为50%和82% - 100%。在第三组中，单阶段/多阶段颊黏膜尿道成形术的有效率估计为0%/100%。在第四组中，DVIU/尿道成形术/会阴前列腺切除术的有效率分别为20%/75%/100%。
在大型特大城市中，医源性尿道狭窄的比例可达45%。医源性尿道狭窄最常见于导尿和经尿道干预。医源性狭窄的每个亚组都有其尿道海绵体纤维化的部位、范围和程度的特点。正确选择手术方式时，尿道成形术的效果几乎是DVIU的两倍。
