Madec F-X, Karsenty G, Yiou R, Robert G, Huyghe E, Boillot B, Marcelli F, Journel N M
Service d'urologie, hôpital Foch, 40, rue de Worth, 92150 Suresnes, France.
Service d'urologie, hôpitaux universitaires de Marseille Conception, 147, boulevard Baille, 13005 Marseille, France.
Prog Urol. 2021 Dec;31(16):1055-1071. doi: 10.1016/j.purol.2021.07.012. Epub 2021 Oct 5.
The purpose of this first french guideline is to provide a clinical framework for the diagnosis, treatment and follow-up of anterior urethral strictures. The statements are established by the subgroup working on uro-genital reconstruction surgery (GURU) from the CAMS-AFU (Andrology and Sexual Medicine Committee from the French Association of Urology).
These guidelines are adapted from the Male Urethral Stricture : American Urological Association Guideline 2016, updated by an additional bibliography from January 2016 to December 2019. Twenty-seven main scenarios seen in clinical practice are identified: from diagnosis, to treatment and follow-up. In addition, this guidelines are powered by anatomical diagrams, treatment algorithms, summaries and follow-up tables.
Anterior urethral strictures are a common condition (0,1 à 1,4 %) in men. The diagnosis is based on a trifecta including an examination with patient reported questionnaires, urethroscopy and retrograde urethrography with voiding cystourethrography. Short meatal stenosis can be treated by dilation or meatotomy, otherwise a urethroplasty can be performed. First line treatment of penile strictures is urethroplasty. Short bulbar strictures (<2cm) may benefit from endourethral treatment (direct visual internal urethrotomy or dilation). In case of recurrence or when the stenosis measures more than 2 cm, a urethroplasty will be proposed. Repeated endourethral treatment management are no longer recommended except in case of palliative option. Urethroplasty is usually done with oral mucosa graft as the primary option, in one or two stages approach depending on the extent of the stenosis and the quality of the tissues. Excision and primary anastomosis or non-transecting techniques are discussed for bulbar urethra strictures. Follow-up by clinical monitoring with urethroscopy, or retrograde urethrography with voiding cystourethrography, is performed at least the first year and then on demand according to symptoms.
Anterior urethral strictures need an open surgical approach and should be treated by urethroplasty in most cases. This statement requires a major paradigm shift in practices. Training urologist through reconstructive surgery is the next challenge in order to meet the demand.
本首部法国指南旨在为前尿道狭窄的诊断、治疗及随访提供临床框架。这些声明由法国泌尿外科学会男性学与性医学委员会（CAMS - AFU）的泌尿生殖重建手术亚组（GURU）制定。
本指南改编自《男性尿道狭窄：美国泌尿外科学会2016年指南》，并通过2016年1月至2019年12月的补充参考文献进行更新。确定了临床实践中出现的27种主要情况：从诊断到治疗及随访。此外，本指南配有解剖图、治疗算法、总结及随访表。
前尿道狭窄在男性中是一种常见病症（0.1%至1.4%）。诊断基于一个三联法，包括结合患者报告问卷的检查、尿道镜检查以及排尿性膀胱尿道造影逆行尿道造影。短尿道口狭窄可通过扩张或尿道口切开术治疗，否则可进行尿道成形术。阴茎狭窄的一线治疗是尿道成形术。短球部狭窄（<2cm）可能受益于内镜治疗（直视下内尿道切开术或扩张）。在复发或狭窄长度超过2cm时，将建议进行尿道成形术。除姑息性选择外，不再推荐重复内镜治疗。尿道成形术通常以口腔黏膜移植作为主要选择，根据狭窄程度和组织质量采用一期或二期手术方式。对于球部尿道狭窄，讨论了切除及一期吻合或非横断技术。至少在第一年通过尿道镜临床监测或排尿性膀胱尿道造影逆行尿道造影进行随访，然后根据症状按需进行随访。
前尿道狭窄需要开放手术方法，在大多数情况下应通过尿道成形术治疗。这一观点需要在实践中进行重大范式转变。通过重建手术培训泌尿外科医生是满足需求的下一个挑战。
