Hosseini Jalil, Fallah-Karkan Morteza, Rahavian Amirhossein, Soleimanzadeh Farzin, Salimi Hojjat, Ghadimi Keyvan, Fahim Maryam
Professor of Urology, Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University Medical Science Tehran, Iran.
Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences Tehran, Iran.
Am J Clin Exp Urol. 2019 Dec 15;7(6):378-383. eCollection 2019.
Current methods for Urethral dilatation include filiforms and followers, metal sounds, balloon dilators, catheters of increasing size, introduction of a Council catheter over a guidewire, and coaxial dilators of increasing size. These methods however are effective but expensive and use of them is limited in many third world countries. In this retrospective study, we report the feasibility, complication and long-term follow-up of the newly Nelaton based urethral dilation method following by self calibration plan as a single referral center experience. We reviewed the records of 333 men with urethral stricture longer than 1 cm over a 16-year period between March 2001 to December 2018. In this method the straight flexi-tip guide-wire is introduced through the urethra and advanced under cystoscopic vision. This wire then was used to guide the dilatation after withdrawal of the cystoscope. The tip of well-lubricated Nelaton urethral catheters incised and then advanced gently over the guide-wire serially from the smallest to the largest appropriate sizes. The patients were followed up regularly after the dilatation 1, 3, 6, 12 months and then annually postoperatively with taking history, PVR and uroflowmetry and all underwent retrograde urethrography at the 6 and 12 months of follow-up. The mean age of patients was 39.19±16.9 years old (10 to 86 years). The mean period of the follow-up was 3.6±1.1 years (range, 3 to 4.3 years). Success rate after first attempted was 58.5% and after two attempted was 77.7% in two years follow up. After one year 51 (15.3%), two years 23 (6.9%) and after three years 11 (3.3%) cases required continued self dilatation once a month. Guide wire-assisted urethral dilatation is shown to be acceptable, cost-effective, simple, safe and feasible techniques for urethral dilation. Our technique may be the choice manner in selected patients with short memberanous urethral stricture, because of decrease the risk of incontinency.
目前的尿道扩张方法包括丝状探子和跟随探子、金属探条、球囊扩张器、尺寸递增的导尿管、经导丝置入考克导尿管以及尺寸递增的同轴扩张器。然而，这些方法虽有效但成本高昂，在许多第三世界国家的应用受到限制。在这项回顾性研究中，我们报告了以新的基于内拉通导管的尿道扩张方法并结合自我校准方案作为单一转诊中心经验的可行性、并发症及长期随访情况。我们回顾了2001年3月至2018年12月期间16年里333例尿道狭窄长度超过1厘米的男性患者的记录。在这种方法中，将直的可弯曲头导丝经尿道插入并在膀胱镜直视下推进。然后在拔出膀胱镜后，用这根导丝引导扩张。将充分润滑的内拉通尿道导管尖端切开，然后从小号到合适的大号依次轻柔地沿导丝推进。扩张术后，患者在1、3、6、12个月时定期随访，之后每年随访，记录病史、残余尿量和尿流率，所有患者在随访6个月和12个月时均接受逆行尿道造影。患者的平均年龄为39.19±16.9岁（10至86岁）。平均随访时间为3.6±1.1年（范围为3至4.3年）。在两年的随访中，首次尝试后的成功率为58.5%，两次尝试后的成功率为77.7%。一年后，51例（15.3%）、两年后23例（6.9%）以及三年后11例（3.3%）患者需要每月进行一次持续的自我扩张。导丝辅助尿道扩张被证明是一种可接受的、具有成本效益的、简单、安全且可行的尿道扩张技术。由于降低了尿失禁风险，我们的技术可能是选定的短段膜部尿道狭窄患者的首选方法。
