Türkmen Nihat, Bursalı Kerem
Urology Department, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, 34396 İstanbul, Turkey.
Ministry of Health, Cızre Dr. Selahattin Cızrelıoğlu State Hospital, 73200 Cizre, Turkey.
Arch Esp Urol. 2024 Nov;77(9):978-983. doi: 10.56434/j.arch.esp.urol.20247709.139.
This study aimed to compare the efficacy of various injection therapy agents used in combination with internal urethrotomy in preventing fibrosis and stricture recurrence.
Patients who underwent direct vision internal urethrotomy (DVIU) in our clinic between 2017 and 2022 were retrospectively screened. The patients were divided into four groups: DVIU + intralesional platelet-rich plasma (DVIU + PRP group, n = 21), DVIU + intralesional mitomycin-C (DVIU + MMC group, n = 21), DVIU + intralesional prednisolone (DVIU + prednisolone group, n = 21), and DVIU alone (control group, n = 21). The length (mm) and diameter (mm) of the recurrent urethral strictures and maximum urinary flow rate (Q) on uroflowmetry evaluation were measured at 1, 3, and 6 months postoperatively and compared between the four groups.
Urethral stenosis recurred in two (9.5%) patients in the DVIU + PRP group, three (14.3%) in the DVIU + MMC group, seven (33.3%) in the DVIU + prednisolone group, and nine (42.9%) in the control group. The reduction in stenosis recurrence significantly differed between the four groups ( = 0.040). A significant group difference in stenosis length ( = 0.047) but not in stenosis diameter ( = 0.385) was observed in patients with recurrent stenosis. Furthermore, no significant difference in Q was found between the groups at 1, 3, and 6 months postoperatively ( = 0.588, = 0.047, = 0.067, respectively).
Different intralesional treatments combined with internal urethrotomy demonstrate varying efficacy in reducing urethral stricture recurrence. Considering its high success rate, low cost, and reduced side effects, PRP may be the preferred intralesional treatment option in combination with DVIU.
本研究旨在比较各种注射治疗药物与内尿道切开术联合使用在预防纤维化和狭窄复发方面的疗效。
回顾性筛选2017年至2022年在我院接受直视下内尿道切开术（DVIU）的患者。患者分为四组：DVIU + 病灶内注射富血小板血浆（DVIU + PRP组，n = 21）、DVIU + 病灶内注射丝裂霉素-C（DVIU + MMC组，n = 21）、DVIU + 病灶内注射泼尼松龙（DVIU + 泼尼松龙组，n = 21）和单纯DVIU（对照组，n = 21）。术后1、3和6个月测量复发性尿道狭窄的长度（mm）和直径（mm）以及尿流率评估中的最大尿流率（Q），并在四组之间进行比较。
DVIU + PRP组有2例（9.5%）患者出现尿道狭窄复发，DVIU + MMC组有3例（14.3%），DVIU + 泼尼松龙组有7例（33.3%），对照组有9例（42.9%）。四组之间狭窄复发率的降低有显著差异（P = 0.040）。在复发性狭窄患者中，观察到狭窄长度存在显著组间差异（P = 0.047），但狭窄直径无显著差异（P = 0.385）。此外，术后1、3和6个月时各组之间的Q无显著差异（分别为P = 0.588、P = 0.047、P = 0.067）。
不同的病灶内治疗与内尿道切开术联合使用在减少尿道狭窄复发方面显示出不同的疗效。考虑到其高成功率、低成本和较少的副作用，PRP可能是与DVIU联合使用时首选的病灶内治疗选择。
