Mazdak Hamid, Tolou Ghamari Zahra, Khorrami AbdoulKarim
Isfahan Kidney Transplantation Research Center.
Department of Urology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Curr Urol. 2020 Dec;14(4):206-210. doi: 10.1159/000499237. Epub 2020 Dec 18.
BACKGROUND/AIMS: Previous publications confirmed that after internal urethrotomy success rates in the short-term (less than 6 months) are varied (70-80%) and in the long-term results are generally low. In this study, the efficacy of triamcinolone instillation based on a newly introduced protocol on the rate of recurrence in patients with anterior urethral strictures was evaluated.
A total of 66 patients were divided into treatment group (n = 33), in which triamcinolone was instilled on urethra after removing of Foley catheter and control group (n = 33) that not received any intervention. Each 40 mg/1 ml of triamcinolone vial was dissolved in 9 ml of distilled water and then a 2 ml of diluted solution was used for each instillation and 8 ml was kept in 4°C. Triamcinolone was instilled based on daily in week 1, every other day for week 2 and then every Monday and Friday for 2 months. Penile clamp was used after instillation for 1 hour. Treatment failure was based on urine flow rate, rate of recurrence and time to appearance of recurrence.
There were not any significant differences regrading to age (p = 0.09), length (p = 0.41) and diameter (p = 0.36) of stricture between 2 groups. Time to appearance of recurrence showed significantly in the treatment group when compared with that in the control group (1,350 ± 900 vs. 124.3 ±112 days; p < 0.01). In the treatment group, 88% had reasonable consequence, while in control 48%. There were 3 patients with a mean length-diameter of stricture around 0.3-5 cm who showed recurrence free with the mean of 720 days after intervention.
Administration of triamcinolone instillation in urethra is associated with a decreased risk of stricture recurrence. Superior outcomes were seen in patients with a stricture length of more than 2 cm and this may in part reflect the increasing efficacy of the instillation method in the management of urethral strictures. These findings help identify patients with aggressive features of strictures in urethra who may benefit from intensified treatment efficacy of triamcinolone instillation.
背景/目的：既往文献证实，尿道内切开术后短期（少于6个月）成功率各异（70 - 80%），长期效果总体较差。本研究评估了基于新引入方案的曲安奈德灌注对前尿道狭窄患者复发率的疗效。
共66例患者分为治疗组（n = 33），在拔除Foley导尿管后于尿道内灌注曲安奈德；对照组（n = 33）未接受任何干预。将每支40 mg/1 ml的曲安奈德小瓶溶于9 ml蒸馏水中，每次灌注使用2 ml稀释溶液，8 ml保存于4°C。第1周每日灌注曲安奈德，第2周隔日灌注，之后2个月每周一和周五灌注。灌注后使用阴茎夹1小时。治疗失败依据尿流率、复发率和复发时间判定。
两组在狭窄的年龄（p = 0.09）、长度（p = 0.41）和直径（p = 0.36）方面无显著差异。与对照组相比，治疗组的复发时间显著延长（1,350 ± 900天对124.3 ± 112天；p < 0.01）。治疗组中88%取得了合理效果，而对照组为48%。有3例狭窄平均长度 - 直径约为0.3 - 5 cm的患者，干预后平均720天未复发。
尿道内灌注曲安奈德可降低狭窄复发风险。狭窄长度超过2 cm的患者效果更佳，这可能部分反映了灌注方法在尿道狭窄管理中疗效的提高。这些发现有助于识别可能从前尿道狭窄强化治疗疗效中获益的具有侵袭性特征的患者。
