经尿道绿激光瘢痕汽化术治疗良性前列腺增生术后后尿道狭窄

目的研究采用绿激光在膀胱尿道软镜配合下治疗前列腺增生术后后尿道狭窄的临床疗效。方法使用绿激光对前列腺增生术后后尿道狭窄的患者18例进行经尿道绿激光瘢痕汽化术,所有患者术前经膀胱尿道软镜检查确诊。其中前列腺摘除术后10例,经尿道前列腺电切术后8例。术后留置尿管1周至1个月。结果 18例患者手术均一次性成功,手术时间25～90min,平均67min,随访2～8个月,15例患者术后即治愈,其余3例患者经多次定期尿道扩张后4～8个月内治愈,无尿失禁患者出现。结论绿激光治疗前列腺增生术后后尿道狭窄安全有效。     

经尿道绿激光汽化术治疗尿道狭窄的疗效观察

目的:比较经尿道绿激光与尿道狭窄内切开及电切术治疗尿道狭窄的临床疗效.方法:15例尿道狭窄患者行经尿道绿激光汽化(A组),18例行经尿道内切开及电切(B组),分析两组患者手术时间、术后住院日、术后最大尿流率、尿道狭窄复发率及再次手术率等指标,并比较临床疗效.结果:随访6～12月,两组术后住院日、术后最大尿流率差异无统计学意义(P>0.05),但A组手术时间、尿道再次狭窄发生率及再次手术率均低于冷刀内切开B组(P<0.05).结论:经尿道绿激光汽化优于尿道狭窄内切开及电切术治疗尿道狭窄.     

输尿管镜下铥激光治疗尿道狭窄65例临床分析

目的 探讨输尿管镜下结合铥激光技术尿道内切开治疗尿道狭窄及闭锁中的效果.方法 本院于2005年1月～2010年12月期间对65例尿道狭窄或闭锁的患者在输尿管镜下行铥激光尿道狭窄处内切开术,切除局部纤维瘢痕组织,修整尿道黏膜面,使管腔光滑;尿道闭锁者先行4号尿道探子经耻骨上膀胱造瘘口,沿膀胱前壁滑入尿道内口,然后经尿道置入输尿管镜与尿道探子对接.找到尿道后,将4号输尿管导管经输尿管镜插入膀胱内,输尿管镜随后穿越狭窄段进入膀胱内.铥激光放射状切开尿道狭窄环,并切除、修整尿道内面瘢痕组织,使管腔光滑,直至顺利通过20号尿道探子.结果 所有患者手术过程均顺利,55例一次手术治愈,4例经多次尿道扩张后治愈,4例在术后3个月至1年再次尿道狭窄,行铥激光内切开后治愈,2例3次铥激光内切开手术后治愈.术后前尿道瘘1例,持续导尿后自愈.术后3个月、6个月平均最大尿流率分别为(22.3±3.3)ml/s,(20.1 ±2.5)ml/s.结论 输尿管镜结合铥激光行尿道内切开加瘢痕切除术是治疗尿道狭窄及闭锁安全、创伤小、并发症少,疗效显著,有效的治疗方法.     

小儿输尿管镜钬激光内切开术治疗男性尿道狭窄

目的探讨小儿输尿管镜钬激光内切开术治疗男性尿道狭窄的安全性及临床疗效。 方法回顾性分析2014年8月至2017年4月我院42例行经尿道小儿输尿管镜钬激光内切开术治疗的男性尿道狭窄患者病历资料,患者年龄23～72岁,平均43岁,其中膜部尿道狭窄18例,前列腺部尿道狭窄5例,前尿道狭窄19例;狭窄段长度：0.3～2.5 cm,平均（1.4±0.3）cm,其中2例狭窄段长度2.0～2.5 cm;38例术前行自由尿流率检查,最大尿流率（Qmax）2.5～7.8 ml/s,平均（4.5±1.2）ml/s;术后留置尿管4～6周,拔除尿管后常规行尿道扩张3～4次,每次间隔1周,定期复查尿流率。 结果42例患者均顺利完成手术,手术时间30～70 min,平均（48±9）min,出血量少,无尿外渗、穿孔、感染等并发症,拔除尿管后排尿通畅。随访6～12个月,39例患者排尿通畅,最大尿流率明显改善,为12.6～22.5 ml/s,平均（16.3±3.7）ml/s,3例术后3个月尿线变细、尿流率下降行尿道扩张3～4次后排尿正常。 结论经尿道小儿输尿管镜钬激光内切开术治疗男性尿道狭窄安全、创伤小、并发症少,近期疗效满意。     

经输尿管镜钬激光治疗男性尿道狭窄的临床体会

目的探讨经输尿管镜钬激光治疗男性尿道狭窄的安全性及有效性。方法经尿道输尿管镜直视下钬激光内切开术治疗男性尿道狭窄31例,术后留置导尿2-4周。结果 31例患者均顺利完成手术,术毕均能通过F24尿道扩张器,术中术后无明显出血及直肠损伤、尿漏、尿失禁等并发症,所有患者在拔除导尿管后均自行排尿。术后随访3-24月,3个月内有3例尿道狭窄复发,3个月后另有8例尿道狭窄复发,均予定期尿道扩张至治愈。结论经尿道输尿管镜下钬激光内切开术治疗尿道狭窄是安全有效的。     

输尿管镜下钬激光切开术治疗尿道狭窄疗效观察

目的探讨输尿管镜下钬激光切开术治疗尿道狭窄的疗效。方法16例患者采用经尿道输尿管镜下钬激光切开术治疗,狭窄长度0．1～1．0cm,观察其术中出血、术后并发症及疗效。结果16例患者均顺利完成手术,疗效满意,术中出血少,术后最大尿流率（Qmax）较术前有明显改善,无严重并发症发生。结论输尿管镜下钬激光切开术治疗对尿道狭窄是一种安全、微创且行之有效的治疗方法。     

尿道内钬激光切开术治疗尿道狭窄的疗效观察

目的 探讨尿道内钬激光切开术治疗尿道狭窄的可行性.方法在直视下应用尿道镜对37例尿道狭窄患者施行尿道内钬激光切开术治疗.结果 35例手术成功,2例中转改开放手术.术后无大出血、尿外渗、直肠损伤等并发症发生,平均最大尿流率为(16～23.5)ml/s,术后随访6～12个月无尿道再狭窄发生.结论尿道内钬激光切开术是治疗尿道狭窄安全,有效的方法.     

经尿道绿激光瘢痕汽化与尿道狭窄内切开及电切术治疗尿道狭窄的疗效比较

目的比较经尿道绿激光瘢痕汽化与尿道狭窄内切开及电切术治疗尿道狭窄的疗效。方法分析33例经尿道绿激光瘢痕汽化（A组）和41例尿道狭窄内切开及电切术（B组）治疗尿道狭窄的临床资料。比较两组手术时间、住院时间、手术有效率、并发症的发生率、术后最大尿流率、术后尿道扩张次数的差异。结果两组间的手术时间、手术有效率和术后最大尿流率差异无统计学意义（P〉0．05）,但A组住院时间、手术并发症的发生率、术后尿道扩张的次数显著少于B组fP〈0．05）。结论经尿道绿激光瘢痕汽化优于尿道狭窄内切开及电切术治疗尿道狭窄。     

尿道狭窄分类治疗的临床观察

目的 为探讨合理应用尿道扩张器、筋膜扩张器以及绿激光等腔内微创技术治疗尿道狭窄的临床方法.方法 回顾性分析2008年6月至2010年6月收治的39例男性尿道狭窄患者的治疗过程.所有患者根据膀胱尿道软镜的检查结果确定治疗方式,筋膜扩张器扩张联合尿道扩张器治疗25例,尿道狭窄绿激光汽化术治疗14例.结果 所有患者均治疗成功.术后拔除导尿管后最大尿流率较术前明显改善.结论 根据病变部位及程度对尿道狭窄患者分类并采用不同治疗方式,是处理尿道狭窄操作性强、成功率高及安全有效的治疗方法.     

KTP／532激光在治疗后尿道狭窄中的应用

目的探讨经尿道KTP／532激光治疗后尿道狭窄的临床效果。方法2005年3月～2008年6月,采用KTP／532激光汽化尿道瘢痕组织治疗后尿道狭窄患者39例。结果39例均一次手术成功。手术时间15～35min,平均28min;术后1～2d拔除导尿管．35例排尿通畅,最大尿流率（Qmax）〉15mL／s;4例排尿不畅,Qmax〈8mL／s,尿动力学检查显示与膀胱逼尿肌功能减遐有关。术后1个月,平均最大尿流率由术前的（5．6±2．1）mL／s升至（16．7±3．6）mL／s。36例获得随访3～18个月,3铡术后1个月发生尿流变细,经定期行尿道扩张后排尿通畅。结论经尿道KTP／532激光汽化术治疗后尿道狭窄安全有效,手术操作简单,术后恢复快,并发症少。     

新型KTP/532激光在尿道闭锁治疗中的应用

目的探讨经尿道KTP／532激光治疗尿道闭锁的疗效。方法使用新型KTP／532激光对18例男性尿道闭锁患者进行经尿道汽化瘢痕切除。年龄19～61岁，平均35岁。尿道闭锁原因：骨盆骨折合并后尿道断裂16例，球部尿道骑跨伤2例。病程10个月～4年。闭锁长度1．6～2．5cm，平均1．9cm。术后均留置导尿管4～8周，拔管后行尿流率等检查。结果手术均一次成功，手术时间20～60min，平均35min。除1例出现少量尿外渗外，余17例未出现并发症。随访2～6个月，16例一次治愈，排尿通畅，Qmax均＞15ml／s；2例拔除尿管后2周尿线变细，Qmax＜9ml/s，行定期尿道扩张后治愈，Qmax＞15ml／s。结论经尿道新型KTP／532激光治疗尿道闭锁安全有效，手术操作简便，恢复快，并发症少。     

双窥镜法联合钬激光内切开术治疗严重尿道狭窄疗效观察

目的观察双窥镜法联合钬激光内切开术治疗严重尿道狭窄的初期疗效。方法2005年5月至2009年4月,应用双窥镜法联合钬激光内切开术治疗8例尿道狭窄或尿道闭锁,狭窄段长度0.8-2.5cm。结果8例患者均尝试逆行内切开术均无法通过狭窄段,应用双窥镜法联合钬激光内切开术治疗均获成功,术后留置尿管4-6周,拔管后均排尿通畅,无尿失禁。8例患者中7例获随访6.24个月（平均18个月）,其中2例患者无需任何后续治疗,3例需行6-16次尿道扩张（平均11次）以维持正常排尿;2例术后3及4个月再次因尿道狭窄行开放手术治疗。结论双窥镜法联合钬激光内切开术治疗尿道狭窄提高了一期腔内手术的成功率,可作为严重尿道狭窄、尿道闭锁患者的可选微创治疗术式。该术式早期疗效良好,但远期效果不尽满意尚待长期观察。     

The surgical treatment of urethral strictures

The authors reviewed the results of surgical management of 233 patients aged 8-76 years who had suffered urethral strictures. A total of 266 operations were made in the period of 1970-1989. Urethral tunneling which had been widely used in clinical practice for strictures of the urethra until 1980 yielded 91.2% recurrences of the disease, which made surgeons modify the surgical policy. During the past decade 127 patients with urethral strictures and obliterations have undergone 138 surgical interventions: 91 (65.9%) urethral resections, 34 (24.6%) internal optical urethrotomies and transurethral resections of scarring tissue, 7 (5.1%) cutaneous urethral plastic surgeries and only 6 (4.4%) urethral tunnelings. The number of relapses was reduced to 13.4%. The authors consider that urethral resection should be the operation of choice in urethral strictures and obliterations. Endoscopic treatment techniques (urethrotomy and transurethral resection) are indicated in short strictures and scarring deformity of the posterior urethra after prostate operation. It is advisable to apply cutaneous urethral plastic surgery in case of extended strictures.     

A prospective randomized controlled trial of hybrid laser treatment or transurethral resection of the prostate, with a 1-year follow-up

OBJECTIVE: To compare the clinical outcome after hybrid laser treatment of the prostate, combining potassium titanyl phosphate (KTP) and Nd:YAG lasers, with transurethral resection of the prostate (TURP). PATIENTS AND METHODS: A prospective randomized trial was conducted to compare laser treatment and TURP. The hybrid laser treatment technique involved performing initial 30 W KTP vaporizing bladder neck incisions and prostatotomies followed by a 'free-paint' application of 60 W Nd:YAG coagulation energy. Patients were re-assessed after 6 weeks, 6 months and 1 year, using the International Prostate Symptom Score (IPSS) and uroflowmetry. TURP was conducted using conventional methods. RESULTS: In all, 204 patients were randomized into the study; at 6 weeks there were significant differences between the groups for the IPSS (12.4 vs 9.1, P=0.001) and maximum urinary flow rates (16.1 vs 20.8 mL/S, P<0. 001) in favour of the TURP group. At 6 months and one year this difference had disappeared. Similar numbers of patients in each group complained of bothersome postoperative urinary symptoms (23% vs 19%). Blood transfusions (5% vs none) and urethral strictures (9% vs 2%) were more common after TURP, whereas more early infective complications occurred after hybrid laser treatment (24% vs 5%). Only one patient in each group required re-operation because of poor resolution of symptoms. CONCLUSIONS: At one year, hybrid KTP/Nd:YAG laser treatment of the prostate was equivalent to TURP in the improvements in IPSS, maximum urinary flow rate and post-void residual urine.     

Holmium laser ablation of recurrent strictures of urethra and bladder neck: preliminary results

BACKGROUND: The management of patients with recurrent urethral strictures represents a challenge for the practicing urologist. PATIENTS AND METHODS: We used holmium:yttrium-aluminum-garnet (Ho:YAG) laser in the management of recurrent urethral strictures in 13 patients. The energy level was set at 1.0 at a frequency of 10 pulses/sec. No treatment complications were observed. The mean preoperative maximum flow rate by uroflowmetric analysis was 3.8 mL/sec. RESULTS: Nine patients (69%) continue to do well with no symptoms at a median follow-up of 27 months with a mean maximum flow rate of 19 mL/sec. Of the four patients in whom treatment failed, three were retreated with the Ho:YAG laser. One of them was managed by insertion of a permanent urethral stent, another continues to do well without any further treatment, and the other is managed with dilation by self-catheterization. One of the four failures underwent open reconstructive urethroplasty after recurrence following his first treatment with the Ho:YAG laser. CONCLUSION: Our preliminary results suggest that Ho:YAG laser ablation of urethral strictures is safe and might be a reasonable alternative endoscopic treatment for recurrent urethral strictures.     

Treatment of urethral diseases with neodymium:YAG laser

Over a thirty-month period, a wide variety of common urethral problems were treated on an ambulatory basis, with the neodymium:yttrium-aluminum garnet (Nd:YAG) laser. When used discriminately, laser treatment appears to be an effective modality for the management of selected urethral strictures. Thus far, excellent results have been obtained in 30 of 31 cases of short strictures where laser urethrotomy was performed as the first stricture procedure (average follow-up 10 months). Furthermore, in a series of 36 cases of secondary bladder neck contractures, all of the evaluated patients responded well (average follow-up 7 months). Good results were obtained in only 11 of 48 complicated strictures (average follow-up 14 months). However, while most of these extensive strictures were not eradicated, laser therapy generally produced a documented clinical improvement, comparable to urethrotomy or dilatation, in 15 of these cases. A series of 24 condylomata involving the urethra were treated satisfactorily, with no recurrences (average follow-up 13 months). Laser treatment also has been used successfully for the management of several urethral caruncles, urethral polyps, two meatal hemangiomas, one urethral carcinoma, and a distal duplicated urethra. Recently, the Nd:YAG laser has been applied to the prostatic urethra with vaporization of obstructing median bar hyperplasia. Favorable results have been achieved in 5 of 6 cases treated with a newly developed technique that utilizes direct laser contact. Retrograde ejaculation has not been encountered in these patients (average follow-up 6 months). All of these procedures have been accomplished in the office, largely without urethral catheterization. Lidocaine jelly occasionally supplemented with intravenous sedation provided satisfactory anesthesia.     

Long-term results of carbon dioxide laser treatment of meatal condylomata acuminata

A group of 74 men who underwent carbon dioxide laser treatment of meatal condylomata were observed for an average of 18 months. The cure rate after 1 treatment of isolated meatal lesions was 78%; the presence of external lesions lowered the rate to 32% and additional external and urethral warts to 25%. Following multiple treatments all but 6 patients were cured; 83% of the recurrences developed within 3 months. One urethral and 6 meatal strictures occurred more than 3 months after treatment; 9 patients had a spraying stream many years after treatment and 2 complained of frequency.     

经输尿管镜钬激光联合球囊扩张器治疗尿道狭窄

【摘要】 目的 研究直视下钬激光尿道内切开并球囊扩张治疗尿道狭窄的疗效。方法〓2013年6月至2014年12月,共收治36例尿道狭窄患者,术前详询病史、体检、行尿流率测定及逆行尿道造影,所有病人在尿道狭窄处行直视下钬激光尿道内切开和球囊扩张,术后留置16~18Fr硅胶尿管7~21天,所有病人术后随访6~12个月,随访期间测定尿流率,必要时每3个月进行尿道逆行造影或排泄性尿路造影。结果〓第一次术后治愈30例,总体成功率为83.4%。6例再狭窄和狭窄并尿瘘。结论〓直视下钬激光尿道内切开联合球囊扩张是治疗尿道狭窄安全有效的微创方法。     

口腔内黏膜尿道成形治疗前尿道狭窄10年经验总结

目的 探讨口腔内黏膜尿道成形治疗尿道狭窄的长期效果. 方法 2001年1月至2010年12月,应用口腔内黏膜(颊黏膜和舌黏膜)尿道成形治疗前尿道狭窄255例.尿道狭窄段长度3 ～18 cm,平均6 cm.尿道成形采用保留原尿道板的扩大尿道成形术或埋藏黏膜条背侧替代尿道成形术.对49例尿道狭窄段≥8 cm者采取双侧颊黏膜拼接、颊粘膜与舌黏膜拼接或双侧连续长条舌黏膜尿道成形. 结果 术后随访8 ～120个月,平均37个月.230例患者排尿通畅,尿线粗,最大尿流率为16～51 ml/s,平均26 ml/s.尿道造影显示重建段尿道管腔通畅.总成功率90.2％.25例患者于术后1年内发生并发症,其中尿道再次狭窄17例,尿道皮肤瘘8例.17例尿道再狭窄患者中15例再次行口腔内黏膜尿道成形,2例吻合口狭窄行尿道内切开,术后排尿通畅;8例尿道皮肤瘘均接受尿瘘修补术后治愈. 结论 口腔颊黏膜和舌黏膜均是良好的尿道替代物,舌黏膜取材较颊黏膜更为便利;口腔内多种黏膜的组合移植重建尿道是治疗长段前尿道狭窄( ≥8 cm)的有效方法.