Heyns C F, Steenkamp J W, De Kock M L, Whitaker P
Department of Urology, Faculty of Medicine, University of Stellenbosch and Tygerberg Hospital, South Africa.
J Urol. 1998 Aug;160(2):356-8. doi: 10.1016/s0022-5347(01)62894-5.
We evaluate the efficacy of repeated dilation or urethrotomy as treatment of male urethral strictures.
Between January 1991 and January 1994, 210 men with proved urethral strictures were prospectively randomized to undergo filiform dilation (106) or internal urethrotomy (104). Followup was scheduled at 3, 6, 9, 12, 24, 36 and 48 months. Dilation or internal urethrotomy was repeated at the first and second stricture recurrence. The Kaplan-Meier method was used to estimate survivor function for the treatment methods (survival time being the time to first stricture recurrence) and the log rank test was used to compare the efficacy of different treatments.
Followup (mean 24 months, range 2 to 63) was available in 163 patients (78%). After a single dilation or urethrotomy not followed by re-stricturing at 3 months, the estimated stricture-free rate was 55 to 60% at 24 months and 50 to 60% at 48 months. After a second dilation or urethrotomy for stricture recurrence at 3 months the stricture-free rate was 30 to 50% at 24 months and 0 to 40% at 48 months. After a third dilation or urethrotomy for stricture recurrence at 3 and 6 months the stricture-free rate at 24 months was 0 (p <0.0001).
Dilation and internal urethrotomy are useful in a select group (approximately 70% of all patients) who are stricture-free at 3 months, and of whom 50 to 60% will remain stricture-free up to 48 months. A second dilation or urethrotomy for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or urethrotomy is of no value.
我们评估重复扩张或尿道切开术治疗男性尿道狭窄的疗效。
1991年1月至1994年1月期间，210例经证实患有尿道狭窄的男性被前瞻性随机分为接受丝状探子扩张术（106例）或内尿道切开术（104例）。随访计划安排在3、6、9、12、24、36和48个月。在首次和第二次狭窄复发时重复进行扩张或内尿道切开术。采用Kaplan-Meier法估计治疗方法的生存函数（生存时间为首次狭窄复发时间），并使用对数秩检验比较不同治疗方法的疗效。
163例患者（78%）获得随访（平均24个月，范围2至63个月）。单次扩张或尿道切开术后3个月未再出现狭窄，24个月时估计无狭窄率为55%至60%，48个月时为50%至60%。因狭窄复发在3个月时进行第二次扩张或尿道切开术后，24个月时无狭窄率为30%至50%，48个月时为0至40%。因狭窄复发在3个月和6个月时进行第三次扩张或尿道切开术后，24个月时无狭窄率为0（p<0.0001）。
扩张和内尿道切开术对一组特定患者（约占所有患者的70%）有用，这些患者在3个月时无狭窄，其中50%至60%在48个月时仍无狭窄。因早期狭窄复发（3个月时）进行第二次扩张或尿道切开术在短期内（24个月）价值有限，但长期（48个月）无价值，而第三次重复扩张或尿道切开术则无价值。
