al-Ali M, al-Shukry M
Department of Urology and Transplantation, Al-Rasheed Military Hospital, Baghdad, Iraq.
J Urol. 1997 Jan;157(1):129-31.
We determined whether optical urethral reconstruction, with the use of a Béniqué bougie in the proximal urethra and transrectal digital guidance, is effective for the treatment of long and severe urethral occlusions. However, with some skill the procedure can be done without the bougie for the treatment of short occlusions.
During a 9-year period 154 men with complete urethral occlusion underwent core through optical urethrotomy via transrectal digital guidance, using the Béniqué bougie in 89 (58%). A total of 400 urethrotomies was performed. All lesions were in the posterior urethra except 8 in the pendulous portion. There were 64 war related injuries (41.6%). Combined voiding and retrograde urethrography was not useful to measure the length of the occlusion due to failure of proximal urethral filling. Guided optical urethral reconstruction consisted of optical urethrotomy performed with a Béniqué bougie introduced proximally through the suprapubic catheter site and into the proximal urethra with the index finger of the operator in the rectum. The same procedure was performed blindly without use of the bougie in 65 patients (42%), and in 43 with lesions shorter than 1 cm. and 4 with multiple annular lesions. We also used the blind technique successfully to reestablish 18 occlusions longer than 1 cm. For optimal epithelialization of the urethral tract we suggest leaving a silicone catheter indwelling for 3 months. No prophylactic antibiotics were given.
Of the patients 54 (35%) were cured after 1 procedure, whereas the remaining 100 (65%) required 1 to 9 additional urethrotomies (mean 3). Patients with an uninstrumented urethra who were treated initially with suprapubic catheterization required 1 to 6 urethrotomies (mean 2), compared to 1 to 10 (mean 3) for those who had undergone a prior procedure. Hematuria occurred in 9% of the patients, symptomatic urinary tract infection in 7% and slight extravasation in 3.2%. One patient had stress incontinence.
Our procedure is effective, simple, safe, repeatable, inexpensive and minimally invasive, and it does not require special or sophisticated guiding instruments, which are necessary for previously described techniques. It can be performed with or without use of a Béniqué bougie depending on the extent of the lesion and skill of the surgeon. The outcome can be judged from the symptomatic response of the patient, and flow studies and urethrography are not mandatory during routine followup.
我们确定了在近端尿道使用贝尼凯探条并经直肠指引导下的光学尿道重建术对于治疗长段且严重的尿道闭塞是否有效。然而，凭借一定技巧，对于短段闭塞的治疗可不使用探条进行该手术。
在9年期间，154例完全性尿道闭塞的男性患者经直肠指引导下通过光学尿道切开术进行了核心治疗，其中89例（58%）使用了贝尼凯探条。共进行了400次尿道切开术。除了8例位于悬垂部外，所有病变均位于后尿道。有64例（41.6%）与战争相关的损伤。由于近端尿道充盈失败，联合排尿和逆行尿道造影对测量闭塞长度无用。引导式光学尿道重建包括使用贝尼凯探条经耻骨上导管部位向近端插入并进入近端尿道，术者食指置于直肠内进行光学尿道切开术。65例患者（42%）在不使用探条的情况下盲目进行了相同手术，其中43例病变短于1厘米，4例有多个环形病变。我们还成功地使用盲法技术重建了18例长度超过1厘米的闭塞。为使尿道最佳上皮化，我们建议留置硅胶导管3个月。未给予预防性抗生素。
54例患者（35%）一次手术后治愈，其余100例（65%）需要额外进行1至9次尿道切开术（平均3次）。最初接受耻骨上导管插入术治疗的未使用器械的尿道患者需要进行1至6次尿道切开术（平均2次），而之前接受过手术的患者则需要1至10次（平均3次）。9%的患者出现血尿，7%出现有症状的尿路感染，3.2%出现轻微外渗。1例患者出现压力性尿失禁。
我们的手术有效、简单、安全、可重复、廉价且微创，不需要先前所述技术所需的特殊或复杂的引导器械。根据病变程度和外科医生的技术，可使用或不使用贝尼凯探条进行手术。可根据患者的症状反应判断结果，在常规随访期间不必进行流量研究和尿道造影。
