Klein Roger, Vasan Robin, Guercio Cailey, Rusilko Paul
UPMC Department of Urology, Pittsburgh, Pittsburgh.
UPMC Department of Urology, Pittsburgh, Pittsburgh; UPMC Department of Plastic Surgery, Pittsburgh, Pittsburgh.
Urology. 2024 Jan;183:e317-e319. doi: 10.1016/j.urology.2023.10.006. Epub 2023 Oct 20.
To demonstrate a technique for minimally invasive endoscopic management of posterior urethral strictures, including those at the bladder neck and vesicourethral anastomosis.
Herein, we have included endoscopic video footage from 3 patients with posterior urethral strictures, including 1 at the bladder neck, 1 at the vesicourethral anastomosis, and 1 in the bulbomembranous urethra. In each patient, we perform a direct visualization internal urethrotomy (DVIU) with incisions at the 5 and 7 o'clock positions to widen the urethral lumen, followed by injection of 2 mg mitomycin C (MMC) in a total volume of 5 mL sterile water.
Herein, we describe our technique for the endoscopic management of posterior urethral strictures, including those in the prostatic urethra and bladder neck. MMC injection, in conjunction with traditional DVIU, adds minimally to the complexity and length of the procedure but may substantially improve long-term surgical outcomes.
Bladder outlet obstruction due to stenosis or stricture of the posterior urethra is a common urologic diagnosis whose etiology can often be traced to prior urethral manipulation or iatrogenic trauma. While Americal Urological Assicuation (AUA) guidelines state that dilation or direct visualization internal urethrotomy (DVIU) should be offered for bulbar strictures measuring less than 2 cm in length, recent evidence suggests that DVIU with or without MMC injection may have utility in the management of bladder neck or vesicourethral anastomotic contractures. We have found that DVIU with subsequent MMC injection is a viable minimally invasive approach for the treatment of posterior urethral strictures. While more data are needed to better understand the long-term success rates of these procedures, this approach should be considered for patients with a bladder outlet obstruction secondary to a short stricture of the posterior urethra, bladder neck, or vesicourethral anastomosis.
展示一种用于后尿道狭窄微创内镜治疗的技术，包括膀胱颈和膀胱尿道吻合口处的狭窄。
本文纳入了3例后尿道狭窄患者的内镜视频资料，其中1例位于膀胱颈，1例位于膀胱尿道吻合口，1例位于球膜部尿道。在每例患者中，我们在5点和7点位置进行切口，实施直视下内切开术（DVIU）以扩大尿道腔，随后在5mL无菌水中注射2mg丝裂霉素C（MMC）。
本文描述了我们用于内镜治疗后尿道狭窄的技术，包括前列腺尿道和膀胱颈处的狭窄。MMC注射与传统DVIU相结合，对手术的复杂性和时长增加极少，但可能显著改善长期手术效果。
后尿道狭窄或闭锁所致膀胱出口梗阻是一种常见的泌尿外科诊断，其病因通常可追溯至既往尿道操作或医源性创伤。虽然美国泌尿外科学会（AUA）指南指出，对于长度小于2cm的球部狭窄应采用扩张术或直视下内切开术（DVIU），但最近的证据表明，无论是否注射MMC，DVIU在治疗膀胱颈或膀胱尿道吻合口挛缩方面可能有效。我们发现，DVIU联合后续MMC注射是治疗后尿道狭窄的一种可行的微创方法。虽然需要更多数据来更好地了解这些手术的长期成功率，但对于因后尿道、膀胱颈或膀胱尿道吻合口短段狭窄继发膀胱出口梗阻的患者，应考虑采用这种方法。
