Levine L A, Engebrecht B P
Department of Urology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
J Urol. 1997 Sep;158(3 Pt 1):818-21. doi: 10.1097/00005392-199709000-00034.
We determined the efficacy of adjuvant home balloon self-dilation as an alternative to office dilation and to reduce the likelihood of recurrence in patients with recalcitrant urethral strictures.
A total of 31 men participated in a urethral self-dilating protocol following phallic construction, urethroplasty or visual internal urethrotomy, or as conservative management in 2 nonoperative candidates. Uroflow data and subjective information obtained by blinded questionnaire were reviewed.
The 31 patients were followed for a mean of 18.7 months (range 3 to 45) after initial balloon dilation, and 25 (81%) were available for followup interviews. Of the 25 patients 24 (96%) found no difficulty in learning the technique and 21 (84%) thought they received adequate training with 1 office visit. Most patients noted improvement in voiding with balloon dilation, and peak uroflowmetry rates were preserved or improvement with long-term followup. Six patients (19%) complained of discomfort with balloon placement, 3 (10%) noticed minor bleeding with dilation and 4 (13%) had urinary tract infections during followup. Following visual internal urethrotomy, no stricture recurrences were noted in 9 patients. Strictures recurred in 2 of 13 (15%) urethroplasty patients following balloon dilation. After radial forearm free flap phallic construction, a technique known to have a high re-stricture rate, 5 of 7 patients (71%) had recurrent urethral stricture.
Preliminary results indicate that adjuvant outpatient urethral self-dilation following surgical correction of urethral strictures in patients at high risk for recurrence is inexpensive and safe, as well as a potentially effective option in reducing stricture recurrence and maintaining urethral patency.
我们确定了辅助性家庭球囊自我扩张术作为门诊扩张术的替代方法，并降低难治性尿道狭窄患者复发可能性的疗效。
共有31名男性在阴茎再造、尿道成形术或直视下内尿道切开术后参与了尿道自我扩张方案，或作为2名非手术候选者的保守治疗方法。回顾了尿流数据以及通过盲法问卷获得的主观信息。
31例患者在初次球囊扩张后平均随访18.7个月（范围3至45个月），25例（81%）可进行随访访谈。在这25例患者中，24例（96%）认为学习该技术没有困难，21例（84%）认为经过1次门诊就诊就得到了充分的培训。大多数患者指出球囊扩张后排尿有改善，长期随访时最大尿流率得以维持或有所改善。6例患者（19%）抱怨球囊放置时有不适感，3例（10%）在扩张时出现少量出血，4例（13%）在随访期间发生尿路感染。直视下内尿道切开术后，9例患者未出现狭窄复发。13例尿道成形术患者中有2例（15%）在球囊扩张后出现狭窄复发。在游离前臂桡侧皮瓣阴茎再造术后（一种已知有高再狭窄率的技术），7例患者中有5例（71%）出现复发性尿道狭窄。
初步结果表明，对于有高复发风险的患者，在尿道狭窄手术矫正后进行辅助性门诊尿道自我扩张术成本低廉且安全，也是减少狭窄复发和维持尿道通畅的一种潜在有效选择。
