Isotalo T, Tammela T L, Talja M, Välimaa T, Törmälä P
Division of Urology, Tampere University Hospital, Tampere University of Technology, Finland.
J Urol. 1998 Dec;160(6 Pt 1):2033-6. doi: 10.1097/00005392-199812010-00026.
We studied whether a new bioabsorbable self-expandable, self-retaining and self-reinforced poly-l-lactic acid double spiral stent is able to prevent the edges of a cut recurrent urethral stricture from adhering together and the scar from shrinking, thus obviating stricture recurrence.
A bioabsorbable spiral stent was inserted into the stricture site in the urethra immediately after optical urethrotomy in 22 patients with recurrent urethral stricture. Uroflowmetry, measurement of residual urine volume, urine culture and urethroscopy were performed before and 1, 3, 6 and 12 months after optical urethrotomy.
All 22 patients voided freely on day 1 or 2 after urethrotomy. The stent slipped partially proximal to the stricture and had to be changed in only 1 patient. The stent was totally epithelialized in all but 1 patient at 6 months and had degraded in all at 12 months. The improvement in flow rate was maintained during followup except in 10 patients with stricture recurrence, which was outside the stent area usually close to the external sphincter in 7 and in the stent area in 3. All recurrences were treated with repeat optical urethrotomy and a new stent was inserted. Urinary infections developed in 2 patients and were successfully treated with oral antibiotics.
The self-expandable self-reinforced poly-l-lactic acid double spiral stent is a promising new method in the treatment of recurrent urethral strictures. There is no need to remove the device and no foreign material remains in the urethra. However, longer followup and controlled studies are needed to evaluate all benefits and side effects of this new treatment modality.
我们研究了一种新型生物可吸收的自膨胀、自固定和自增强聚左旋乳酸双螺旋支架是否能够防止复发性尿道狭窄切开处的边缘粘连以及瘢痕收缩，从而避免狭窄复发。
22例复发性尿道狭窄患者在直视下尿道内切开术后立即将生物可吸收螺旋支架置入尿道狭窄部位。在直视下尿道内切开术前以及术后1、3、6和12个月进行尿流率测定、残余尿量测量、尿培养和尿道镜检查。
所有22例患者在尿道内切开术后第1天或第2天排尿通畅。仅1例患者的支架部分滑入狭窄近端而需更换。除1例患者外，所有患者的支架在6个月时完全被上皮覆盖，12个月时均已降解。随访期间，除10例狭窄复发患者外，其余患者的流速改善情况得以维持，其中7例复发位于支架区域外，通常靠近外括约肌，3例位于支架区域内。所有复发患者均接受了再次直视下尿道内切开术并置入新的支架。2例患者发生尿路感染，经口服抗生素治疗成功。
自膨胀自增强聚左旋乳酸双螺旋支架是治疗复发性尿道狭窄的一种有前景的新方法。无需取出该装置，尿道内也不会残留异物。然而，需要更长时间的随访和对照研究来评估这种新治疗方式的所有益处和副作用。
