Tammela T L, Permi J, Ruutu M, Talja M
Division of Urology, Oulu, University Hospital, Finland.
Ann Chir Gynaecol Suppl. 1993;206:80-3.
Although endoscopic optical urethrotomy is the primary treatment for urethral stricture, it is associated with a high recurrence rate, and the essential problem is how to stop the scar from shrinking after cutting. In a controlled study the effect of treatment of recurrent urethral stricture by internal urethrotomy followed by clean intermittent self-catheterization (CIC) for 6 or 12 months was compared in 25 and 24 patients, respectively. Patients learnt easily how to perform CIC: only one patient was not able to do it at home. All patients were evaluated by uroflowmetry before and immediately after urethrotomy, and 3, 6, 9 and 12 months later. Recurrence was defined as the need for further treatment. There was no difference in the recurrence rate between the two groups, but the maximum flow rate was significantly lower at 12 months in the patients who had ceased catheterization at six months. Complications included in two patients asymptomatic bacteriuria and in 10 patients symptomatic urinary infection. CIC is a very satisfactory method of managing patients with recurrent stricture, it is easy to learn, it prevents a decrease in the maximum flow rate and can thus be applied to most patients instead of regular bouginage. On the basis of the present study we could not determine any optimal time for the duration of CIC after urethrotomy, or whether it has any effect on the natural course of the disease.
虽然内镜光学尿道切开术是尿道狭窄的主要治疗方法，但其复发率较高，关键问题是如何在切开后阻止瘢痕收缩。在一项对照研究中，分别对25例和24例患者进行了内镜下尿道切开术，随后进行6个月或12个月的清洁间歇性自家导尿（CIC），比较其对复发性尿道狭窄的治疗效果。患者很容易学会如何进行CIC：只有1例患者在家中无法操作。所有患者在尿道切开术前、术后即刻以及术后3、6、9和12个月均进行尿流率测定评估。复发定义为需要进一步治疗。两组的复发率无差异，但在6个月时停止导尿的患者中，12个月时的最大尿流率显著较低。并发症包括2例无症状菌尿和10例有症状的泌尿系统感染。CIC是管理复发性狭窄患者的一种非常令人满意的方法，容易学会，可防止最大尿流率下降，因此可应用于大多数患者而非定期尿道扩张。基于本研究，我们无法确定尿道切开术后CIC的最佳持续时间，也无法确定其对疾病自然病程是否有任何影响。
