Lal R, Bhatnagar V, Mitra D K
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi.
J Pediatr Surg. 1998 Mar;33(3):518-9. doi: 10.1016/s0022-3468(98)90102-6.
This report discusses the incidence and predisposing factors for postfulguration urethral strictures in 82 boys with posterior urethral valves treated over 20 years and followed up for a period ranging from 1 to 21 years. A urethral stricture developed in three of the 82 patients (3.6%). All newborns and infants with small urethral caliber at presentation were treated on a temporary tubeless diversion, and fulguration of the valves was deferred until 9 to 12 months of age. A 9F resectoscope with a loop electrode was used to fulgurate at 5, 7, and 12 o'clock positions. A definite technical factor leading to a stricture could be identified in one of these three patients. Comparison of the "stricture" group with the "no stricture" group suggested that although dry fulguration did not have a definite correlation with stricture formation, it is best avoided. Refulguration and properly managed preoperative catheterization did not predispose to stricture formation. Meticulous surgical technique and avoiding oversized instrumentation were the most important factors for preventing this complication.
本报告讨论了82例接受后尿道瓣膜治疗超过20年并随访1至21年的男孩中，电灼术后尿道狭窄的发生率及相关诱发因素。82例患者中有3例（3.6%）发生了尿道狭窄。所有就诊时尿道口径小的新生儿和婴儿均接受了临时性无管改道治疗，瓣膜电灼术推迟至9至12个月龄进行。使用带有环形电极的9F电切镜在5点、7点和12点位进行电灼。在这3例患者中的1例中可确定导致狭窄的明确技术因素。“狭窄”组与“无狭窄”组的比较表明，尽管干式电灼与狭窄形成没有明确关联，但最好避免。再次电灼和术前正确处理导尿并未易导致狭窄形成。细致的手术技术和避免使用过大器械是预防该并发症的最重要因素。
