软膀胱镜在尿道内切开治疗尿道狭窄并假道中的应用

2001年3月～2004年2月，我院使用软膀胱镜辅助治疗男性尿道狭窄并假道患者10例，报告如下。     

尿道探子双向造影在后尿道闭锁诊断中的应用

后尿道闭锁多以外伤性、炎性及医源性为主,我院自2005年3月至2009年3月共收治后尿道闭锁患者6例,应用尿道探子进行诊断,确定闭锁尿道部位、长度及移位程度,取得满意效果,现报告如下.     

膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄(附12例报告)

目的:评估膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄的临床疗效。方法:采用膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄男性患者12例,中位年龄33(19～54)岁。术前行尿道探子会师+尿道造影对狭窄部位和长度进行评估,经造瘘口置入膀胱软镜探及尿道内口,经尿道外口置入尿道内切开镜并调暗光源,在膀胱软镜光源引导下行尿道狭窄内切开术,并对手术时间、失血量、并发症进行记录。术后留置尿管1个月,拔除尿管后每月进行随访,术后3个月行尿道造影、尿流率及国际勃起功能指数问卷(IIEF)评分评估。结果:手术均获成功,手术时间(37±12)min,手术后血红蛋白较术前降低(4.5±2.3)g/L,拔除尿管后无尿失禁,术前术后IIEF评分无明显变化(12.4±6.6vs 13.1±7.0,P>0.05)。随访6～22个月,9例无需进一步处理,排尿正常;3例拔除尿管后出现排尿困难和继发性尿道狭窄,给予每周1次尿道扩张,2例连续4周、1例连续6周尿扩后可置入F18尿道探子,排尿正常,术后3个月Qmax均在(16.2±5.8)ml/s以上。结论:膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄简便易行,创伤小,并发症少,近期及远期疗效满意,可作为骨盆骨折术后尿道狭窄的首选治疗方法。     

电子膀胱软镜在男性患者门诊手术中的应用

目的探讨电子膀胱软镜在男性患者门诊手术中的应用价值。方法总结2007年1月至2008年6月采用电子膀胱软镜检查的107例门诊患者及同期行膀胱硬镜检查的203例患者的资料。结果软镜组患者均顺利完成软镜操作，平均手术时间4．3（3～12）min，术中疼痛评分平均0．7（0～2）分，仅5例术中行活检的患者术后24h内出现淡红色肉眼血尿，7例患者术后24h内有轻微的排尿灼热感。硬镜组平均手术时间4．6（3～16）min，术中疼痛评分平均4．6（2～8）分，3例术前超声提示膀胱占位的患者因膀胱颈口抬高明显未检出改行软镜检查，3例出现术后尿潴留并予留置导尿，17例术后72h持续肉眼血尿，6例术后出现尿频、尿急、尿痛等严重尿路刺激症状。两组疼痛评分、并发症发生率均有显著差异P〈0．05。结论电子膀胱软镜具有痛苦小，无盲区，并发症少，适合特殊患者检查等优点，可作为门诊膀胱镜检的男性患者，特别是有排尿困难病史的老年男性的首选方法。     

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.     

软性膀胱镜联合双极等离子电切治疗复杂性后尿道狭窄及闭锁

目的:提高复杂性后尿道狭窄及闭锁腔内手术的安全性及有效性。方法:总结7例后尿道狭窄或闭锁患者应用软性膀胱镜联合双极等离子电切治疗的临床经验。结果:7例患者均一次性手术成功,无手术并发症发生。随访4~28个月,排尿通畅,无复发。结论:软性膀胱镜联合双极等离子电切能迅速正确切除狭窄瘢痕,恢复尿道正常连续性,降低术后复发率,是一种新的安全有效的微创技术。     

窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

目的 研究窄波成像(NBI)电子膀胱软镜在膀胱肿瘤诊断中的应用价值.方法 临床疑似膀胱肿瘤患者31例,采用Olympus ExeraⅡ电子膀胱软镜系统,分别在NBI和普通白光(WLI)视野下检查,顺序采用随机化法,观察时间相同.分别取2种视野下膀胱内所见可疑病灶活检,比较2种检查方法膀胱肿瘤诊断准确率.结果 31例患者中,经病理检查确诊为膀胱尿路上皮癌28例(90%),其中Tis 3例、Ta 15例、T1 7例、T2 3例;低级别癌20例、高级别癌8例;多发病灶16例、单发病灶12例.WLI下共取活检73处,癌组织61处,阳性率84%,确诊膀胱癌23例;NBI下共取活检91处,癌组织80处,阳性率88%,确诊膀胱癌28例.NBI发现癌组织较WLI多19处,2组检出准确率比较,差异有统计学意义(P＜0.05). 结论 NBI诊断膀胱肿瘤的准确率明显高于WLI电子膀胱软镜.     

窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.     

改良尿道拖入术治疗外伤性后尿道狭窄36例疗效分析

目的:探讨中号硅胶引流管作为牵引固定装置的改良尿道拖入术,治疗外伤性后尿道狭窄或闭锁的效果。方法:2001年1月～2005年6月我科采用此方法治疗复杂外伤性后尿道狭窄或闭锁患者36例。其中25例为骨盆骨折外伤后1期尿道会师术术后尿道闭锁,余11例为骨盆骨折外伤后仅行膀胱造瘘术。尿道狭窄长度1.0～4.5cm,平均2.2cm。患者年龄17～59岁,平均44.5岁。术前并发ED9例。结果:术后随访1年,25例排尿通畅,无需尿道扩张;6例术后需行尿道扩张3～6次;3例术后需定期尿道扩张1年以上(1～3个月扩1次);2例失败。手术中无1例需要输血,术后ED患者无增加,无术后尿失禁发生。结论:改良尿道拖入术操作简单,手术效果好,损伤小,无ED、尿失禁发生。     

尿道端端吻合术对外伤性尿道狭窄患者勃起功能影响的临床研究

目的：研究尿道端端吻合术对外伤性尿道狭窄患者勃起功能的影响。方法：对41例采用尿道端端吻合术治疗的骨盆骨折导致尿道损伤（PFUDD）相关尿道狭窄患者手术前后两个阶段进行血管活性药物注射后阴茎血流彩色多普勒超声波（PPuD）检查和国际勃起功能指数-5（IIEF-5）问卷调查,并对数据进行统计学分析。结果：所有41例患者手术前后的IIEF-5评分无显著差异,且勃起功能无明显变化者占大多数,约为56％。各年龄组、狭窄长度组及狭窄部位组患者手术前后的IIEF-5评分均无显著差异,但术后勃起功能提高组、不变组和降低组3组间的狭窄长度差异有统计学意义（2．16±1．49vs2．28±0．88vs3．50±1．53,P=0．0134）,且差异主要存在于降低组与提高组或不变组之间（P=0.0129,o．0165）。轻度及中低度ED组患者术后IIEF-5评分出现明显下降（13．86±1．88VS11．43±3．37,P=0．0202）,而中度及重度ED组患者则无明显变化。非血管性ED组患者手术前后的IIEF-5评分差异有统计学意义（14．88±1．81VS10．88±4．02,P=0．0103）,动脉性和静脉性ED组患者手术前后评分则无明显差别。结论：尿道端端吻合术对PFUDD等外伤相关尿道狭窄患者的勃起功能没有显著影响,患者术后勃起功能的变化情况与狭窄长度、术前性功能状态等有关,而与患者年龄、狭窄部位等没有明确的关系。     

自制导光尿道探子在治疗男性创伤性尿道狭窄或闭琐中的应用

目的：探讨自制导光尿道探子联合输尿管镜及电切镜在治疗男性创伤性尿道狭窄或闭锁中的作用和价值。方法：采用自制导光尿道探子及输尿管镜置入斑马导丝通过尿道狭窄或闭锁部位进入膀胱,再经斑马导丝引导筋膜扩张器扩裂尿道狭窄或闭锁部位,电切尿道瘢痕组织,留置F20硅胶尿管4周。采用此方法治疗创伤性尿道狭窄或闭琐患者27例。结果：21例尿道狭窄患者经输尿管镜置入斑马导丝成功,6例尿道闭锁患者通过自制导光尿道探子建立通道,由输尿管导管引导置入斑马导丝成功。扩裂及电切治疗27例手术均获得成功,恢复正常排尿,其中2例尿道再狭窄者行尿道扩张治愈。结论：自制导光尿道探子联合输尿管镜及电切镜治疗男性创伤性尿道狭窄或闭锁操作简单、安全、有效,损伤小,并发症少,住院时间短,是一种理想的术式。     

白膜加盖成形术治疗悬垂部尿道狭窄临床研究

目的：探讨白膜加盖成形术治疗悬垂部尿道狭窄的临床疗效。方法：采用尿道背侧切开阴茎海绵体白膜加盖成形方法治疗悬垂部尿道狭窄患者12例．术前最大尿流率（5．9±2．7）ml／s．术后随访分别行逆行尿道造影及尿流率检查．结果：12例术后随访平均24（3~38）个月。术后2年排尿通畅10例;再次狭窄2例,1例经尿道扩张后维持正常排尿。1例再次手术,总成功率为92％．结论：白膜加盖成形术是治疗悬垂部尿道狭窄的有效方法。     

尿道狭窄的腔内治疗（附56例报告）

目的：探讨尿道狭窄的腔内治疗效果。方法：对56例男性尿道狭窄患者联合采用尿道内冷刀及电切镜等腔内技术行尿道内切开术;对并发BPH、输尿管结石或膀胱肿瘤患者一并以电切镜或输尿管镜进行前列腺电切、气压弹道碎石或膀胱肿瘤电切术治疗。结果：本组56例尿道狭窄患者手术均一次成功,拔管后均排尿通畅,仅1例术后因出血而再次住院治疗;无明显尿失禁、尿瘘等并发症。术后根据狭窄段长度定期行尿道扩张。结论：采用经尿道腔内切开术、瘢痕电切术治疗尿道狭窄具有创伤小、并发症少等优点,避免了开放手术痛苦。为降低狭窄复发率,彻底切除瘢痕是必要的;为弥补瘢痕切除不彻底,狭窄段较长患者术后定期行尿道扩张也是必需的。同时,对于尿道狭窄合并BPH、输尿管结石或膀胱肿瘤的患者,在尿道狭窄处理后也可一并处理。     

A Systematic Review of Surgical Techniques Used in the Treatment of Female Urethral Stricture

Context

Female urethral stricture (FUS) is a rare and challenging clinical entity. Several new surgical techniques have been described for the treatment of FUS, although with the limited number of reports, there is no consensus on best management.

Objective

We evaluated the evidence for surgical interventions reported for treating FUS.

Evidence acquisition

We performed a systematic review of the PubMed and Scopus databases, classifying the results by surgical technique and type of graft in the case of graft augmentation urethroplasty.

Evidence synthesis

A total of 221 patients have been reported on with outcome measures after intervention for FUS. The mean age of women was 51.8 yr of age (range: 22–91). All studies were retrospective case series. There was no consistent definition of FUS nor unified diagnostic criteria. Most studies used a combination of diagnostic tests. Where aetiology was defined, idiopathic and iatrogenic stricture were the two most common causes. Ninety-eight patients underwent prior intervention for FUS, mostly urethral dilatation or urethrotomy. Success was defined as the lack of need for further intervention. Urethral dilatation, assessed in 107 patients, had a mean success rate of 47% at a mean follow-up of 43 mo. Fifty-eight patients had vaginal or labial flap augmentation, with a mean success rate of 91% at 32.1 mo of mean follow-up. Vaginal or labial graft augmentation had a mean success rate of 80% in 25 patients at a mean follow-up of 22 mo. Oral mucosal augmentation, performed in 32 patients, had a mean success rate of 94% at 15 mo of mean follow-up. No instances of de novo stress incontinence were reported.

Conclusion

The techniques of urethroplasty all have a higher mean success rate (80–94%) than urethral dilatation (<50%), although with shorter mean follow-up. Urethroplasty in experienced hands appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.