Université de Lille, Department of Urology, Lille Academic Hospital, 59000 Lille, France.
Foch Hospital, Urology Department, Suresnes, France.
Fr J Urol. 2024 Nov;34(11):102714. doi: 10.1016/j.fjurol.2024.102714.
Bulbar urethral strictures are the most frequently encountered. Their management is standardized and needs to be applied to improve results.
A comprehensive literature review was conducted from December 2020 to December 2023, combined with a summary of recommendations from the American, Canadian, European, and French urological associations. References from these recommendations were also used.
Endoscopic treatment is only associated with good results in the case of initial treatment of a short stricture (<2cm). Repeat treatment is not recommended. In all other cases, urethroplasty should be performed. The main techniques, including excision and primary anastomosis (EPA), augmentation and stage urethroplasty, are detailed in this chapter. EPA with or without transection is associated with over 90% success rate for short stenoses. Penile and sexual complications are more frequent with transection of the corpus spongiosum. Augmentation urethroplasty is associated with a similar success rate. The impact of augmentation position on patency has not yet been demonstrated. In the most complicated cases, a stage urethroplasty is required, with a success rate of 33.3-94.6%. Perineal urethrostomy is still a valid option in refractory cases.
This review should provide a better understanding of the different surgical treatments available, in order to propose the best management for each patient.
球部尿道狭窄最为常见。其治疗方法已经标准化，需要加以应用以改善治疗效果。
本研究对 2020 年 12 月至 2023 年 12 月期间的文献进行了全面回顾，并结合了美国、加拿大、欧洲和法国泌尿外科协会的建议总结。这些建议的参考文献也被使用。
内镜治疗仅适用于短（<2cm）狭窄初始治疗的情况，效果良好。不建议重复治疗。在所有其他情况下，应进行尿道成形术。本章详细介绍了主要技术，包括切除和一期吻合术（EPA）、扩张和分期尿道成形术。EPA 联合或不联合切开术治疗短段狭窄的成功率超过 90%。切开海绵体时，阴茎和性功能并发症更为常见。扩张尿道成形术的成功率相似。扩张位置对通畅性的影响尚未得到证实。在最复杂的情况下，需要分期尿道成形术，成功率为 33.3-94.6%。会阴尿道造口术在难治性病例中仍然是一种有效的选择。
本文的综述应该能够更好地理解现有的各种手术治疗方法，以便为每位患者提供最佳的治疗方案。
