输尿管镜直视下钬激光尿道内切开联合球囊扩张术治疗男性尿道狭窄

目的 分析输尿管镜直视下钬激光尿道内切开联合球囊扩张术治疗男性尿道狭窄的临床应用效果.方法 回顾性分析巩义市人民医院泌尿外科2019-01—2020-06收治的35例男性尿道狭窄患者的临床资料,均行输尿管镜直视下钬激光尿道内切开联合球囊扩术.比较术前及术后1个月、3个月、6个月时患者的最大尿流率(Qmax)、残余尿量(...     

输尿管镜下钬激光内切开与内切开联合气囊扩张治疗输尿管狭窄的疗效比较

【摘要】 目的 比较输尿管镜下钬激光内切开与内切开联合期囊扩张治疗输尿管狭窄的临床疗效。方法〓回顾性分析我院从2008年1月到2015年12月入院治疗的66例输尿管狭窄患者的临床资料。以2011年12月之前接受输尿管镜下钬激光狭窄内切开手术治疗的患者为对照组,共30例;2012年1月以后接受输尿管镜下钬激光狭窄内切开联合球囊扩张手术治疗的患者为研究组,共36例。评价两组的临床疗效与并发症等情况。结果〓研究组患者的临床疗效显著优于对照组患者(有效率:73.3% vs 91.7%),差异具有统计学意义(P<0.05);两组患者术中及术后均未见输血尿管穿孔及脱套等严重并发症。结论〓输尿管镜下钬激光内切开联合球囊扩张治疗输尿管狭窄,具有临床疗效显著、损伤小、恢复快等优点,值得临床推广应用。     

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。     

一期球囊扩张联合输尿管软镜下钬激光碎石治疗输尿管狭窄合并肾结石的疗效分析

目的:分析一期球囊扩张联合输尿管软镜下钬激光碎石治疗输尿管狭窄合并肾结石的方法和疗效。方法:2013年1月～2016年1月我院22例输尿管狭窄合并肾结石患者接受一期球囊扩张联合输尿管软镜下钬激光碎石治疗,其中男12例,女10例,年龄23～58岁;输尿管下段狭窄14例,输尿管中段狭窄2例,输尿管上段狭窄6例;输尿管狭窄段0.5～2.0cm,平均1.6cm;结石大小0.6～2.1cm,平均1.6cm。统计分析结石清除率、肾积水变化情况及并发症,对比手术前后IVU造影及CTU检查结果情况。结果:22例手术均顺利完成,术后住院时间2～7d,平均4d,输尿管软镜鞘成功置入率90.9%(20/22),2例术后高热,术后随访6～36个月,平均12个月,一期结石清除率86.4%(19/22),18例输尿管、肾积水明显改善,2例行二次球囊扩张及2例行输尿管整形术后肾积水好转。结论:一期球囊扩张联合输尿管软镜下钬激光碎石治疗输尿管狭窄合并肾结石安全、有效、微创,是一种值得推荐的新方法。     

输尿管镜下钬激光内切开术治疗尿道狭窄和闭锁

目的总结输尿管镜下钬激光内切开术治疗尿道狭窄和闭锁的可行性与疗效。方法总结输尿管镜下钬激光内切开术治疗尿道狭窄和闭锁42例。结果40例患者手术一次成功,成功率95.2%（40/42）,2例手术治疗失败（1例远、近端尿道严重错位,1例尿道瘢痕组织严重）。结论输尿管镜下钬激光内切开术治疗尿道狭窄和闭锁是安全、可行、有效的。     

球囊扩张联合钬激光治疗输尿管狭窄21例临床观察

目的：探讨球囊扩张联合输尿管镜钬激光内切开治疗输尿管狭窄的临床效果。方法：对21例输尿管狭窄的病例,行球囊扩张联合输尿管镜钬激光内切开术治疗,同时处理合并的输尿管结石。结果：21例患者总有效率95％,其中治愈率80．9％、好转率14．2％,1例无效;随访6个月,合并的输尿管结石粉碎后均排出。结论：球囊扩张联合输尿管镜钬激光内切开是治疗输尿管狭窄的首选方法,具有效果满意、创伤小、恢复快和安全等优点。     

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。     

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。     

输尿管镜下钬激光治疗输尿管狭窄效果观察

目的总结并分析输尿管镜下钬激光治疗输尿管狭窄的效果。方法对20例输尿管狭窄患者采用输尿管镜下钬激光治疗。结果 20例患者顺利完成手术,手术时间(38.12±5.08)min,术后住院时间(5.12±1.81)d。术后6例出现轻度肉眼血尿,1~3 d内自行消失。未发生输尿管穿孔、漏尿及严重感染并发症。术后6~12周拔除双J管。随访6~12个月,治疗总有效率95.00%(19/20)。1例无效者术后5月行输尿管狭窄段切除及端端吻合术后治愈。结论输尿管镜下钬激光切开治疗输尿管狭窄,有效率高、并发症少。     

直视下经尿道内切开术治疗尿道狭窄

目的：探讨直视下经尿道内次切开术治疗尿道狭窄的有效性和安全性。方法：总结直视下经尿道内切开术治疗68例尿道狭窄和闭锁患者的疗效和经验，63例1次手术成功；3例行2次、2例行3次成功。结果：68例中，57例术后随访3～71个月，平均28．3个月，43例(75％)均排尿通畅；2例暂时性尿失禁者分别于术后3～6月内恢复。结论：直视下经尿道内切开术创伤小，并发症少，疗效确切，是尿道狭窄和闭锁的首选治疗方法。     

Internal urethrotomy of urethral stricture under vision — a five-year report

Summary This report deals with experience with the method of transurethral incision of urethral strictures under vision in 547 patients involving 662 internal urethrotomies between Nov. 1972 and Aug. 1977. Follow-up examinations showed good results in 79, 3% of the patients. Transurethral incision of urethral strictures can be recommended as the method of choice for the treatment of urethral strictures.     

窥镜直视下尿道内切开术加电切术治疗尿道狭窄

目的：探讨尿道狭窄的有效治疗方法。方法：对1991—2000年收治的128例尿道狭窄患者的临床资料进行回顾性分析，并比较窥镜直视下尿道内切开术和直视下尿道内切开术加电切术的疗效。结果：作单纯直视下尿道内切开术56例，治愈29例(51．9％)。作窥镜直视下尿道内切开术加电切术72例，治愈63例(87．5％)。结论：窥镜直视下尿道内切开术加电切术的方法可明显提高尿道狭窄的疗效，减少其复发率。     

钬激光尿道内切开治疗后尿道狭窄和闭锁疗效观察(附32例报告)

目的：探讨钬激光尿道内切开治疗后尿道狭窄和闭锁的疗效。方法：对32例后尿道狭窄和闭锁患者采用膀胱截石位，于3、9、12点处作放射状钬激光(1．5J，10Hz)内切开治疗，并修整尿道内面，使管腔光滑。遇尿道闭锁时，先采用会师术。结果：一次手术成功率100％，无尿失禁。27例患者获得随访，1年满意者23例(85．1％)，2年满意者18例(66.6％)。结论：采用钬激光尿道内切开治疗后尿道狭窄和闭锁是一种有效手段。     

Holmium laser incision technique for ureteral stricture using a small-caliber ureteroscope.

BACKGROUND AND OBJECTIVES: The holmium laser has a short absorption depth in tissue and possesses excellent properties both in ablation and hemostasis. We have performed endoscopic incision for ureteral stricture using the holmium laser through a small-caliber ureteroscope. METHODS: This method was used on five patients and seven ureters. The etiology of the stricture was stone scar in two patients, ureteroenteroanastomosis of Indiana urinary pouch in two, and primary in one. We used an 8F semi-rigid or 6.9F flexible ureteroscope. No prior procedures, such as balloon dilation, were necessary in any of the cases. The stricture was incised with the holmium laser using a 365-microm fiber through the working channel of the ureteroscope. The holmium laser operated at a wavelength of 2100 nm, with an output of 1.0 J/pulse at a rate of 10 Hz. After completion of the incision, a 12F Double-J catheter was left in for six weeks. RESULTS: The mean operative time was 89 minutes. The stricture resolved completely in all cases at an average follow-up of 8.6 months. CONCLUSIONS: The holmium laser incision for ureteral stricture using a small-caliber ureteroscope is an easy-to-perform, safe and effective procedure.     

Value of preoperative urethral ultrasound in optic internal urethrotomy

INTRODUCTION AND OBJECTIVES: The recurrence rate of internal urethrotomy (IU) is still high (long-term curative success rate between 20 and 45% after the first IU). We aimed to establish in a prospective randomized trial the value of urethral ultrasound in inflammatory urethral stricture (IUS) diagnosis and treatment. PATIENTS AND METHODS: Between June 1994 and January 2004, we performed IU in 562 cases with IUS (under 1.5 cm). In order to evaluate the results obtained by guided incision according to the echographic evaluation, patients have been divided into 2 groups. For the first group (319 cases), the IU technique has been adapted to the echographic aspect of the stricture zone, and to the fibrosis location on the urethral circumference. For patients of the second group (243 cases) we practiced IU with a "classical" 12 o'clock incision. The mean follow-up period was 38.7 months (range 4-71 months) and 37.9 months (range 5-69 months) for the second group. We used the SPSS 8.0 for Windows statistical analysis (Cox regression) with Kaplan-Meier curves in order to compare the recurrence-free survival time. RESULTS: In the first group (44.5% recurrence rate) we found 4 specific locations of urethral stricture fibrosis according to ultrasound evaluation: dorsal urethral fibrosis (274), ventral urethral fibrosis (36), circular urethral fibrosis (136), dorsal and ventral fibrosis (114). The best results have been obtained for the dorsal and ventral location of the spongious fibrosis (45/153 recurrences, 29.4% and 9/22 recurrences, 41%). The recurrence rate was higher in the circular and concomitant dorsal and ventral location of the spongious fibrosis: 67.5% (52/77 cases) and 55.2% (37/67 cases). Cox regression (-2LL=360.859, chi2=47.670, Sig=0.137) demonstrated statistical significance in these series (p<0.5). In the second group (51.5% recurrence rate) we found 64.2% recurrences for the ventral location, 83% for the circular location and 72.3% for the dorsal and ventral location of the spongious fibrosis. CONCLUSIONS: According to our experience, the high recurrence rate of IUS after IU may be explained by the inadequate type of incision. So, urethral ultrasound could improve the IU technique by better location of the fibrosis area.     

经尿道钬激光内切开术治疗尿道狭窄（附32例报告）

目的探讨经尿道钬激光内切开术治疗尿道狭窄的可行性和安全性。方法分析2002年5月至2008年3月32例尿道狭窄和闭锁患者行经尿道钬激光内切开术治疗的临床资料。结果31例患者一次性腔内钬激光内切开治疗成功，1例因狭窄段长达3cm，钬激光内切开失败而改开放手术。无大出血、尿瘘、尿失禁等并发症发生。术后随访3～12个月，均排尿通畅。结论经尿道钬激光内切开术是治疗尿道狭窄的一种简单安全有效的手术方法，创伤小，并发症少，疗效确切。     

输尿管镜联合铥激光内切开术治疗尿道狭窄

目的:探讨输尿管镜联合铥激光内切开治疗尿道狭窄的疗效。方法:尿道狭窄或闭锁36例,采用输尿管镜联合铥激光行尿道内切开,汽化切除尿道瘢痕组织,恢复尿道的连续性,观察其临床疗效及并发症。结果:手术时间10~90 min,平均35 min,术后留置尿管2~6周后均排尿通畅,无尿失禁。随访4~24个月,平均12个月。27例患者无需尿道扩张,5例患者拔管后出现尿线变细,经定期尿道扩张后治愈,3例因未及时行尿道扩张需再次行尿道内切开术,1例行尿道狭窄段切除成形术。结论:输尿管镜联合铥激光行尿道内切开治疗短段尿道狭窄,安全有效,并发症少,住院时间短,亦可作为严重尿道狭窄、尿道闭锁的可选治疗手段,早期疗效良好,但远期效果尚待观察。     

腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁

目的探讨腔镜下钬激光内切开治疗男性尿道狭窄及闭锁的效果及安全性。方法我院2007年4月～2009年11月收治男性尿道狭窄或闭锁病人17例,狭窄段长0.5～3.0cm,平均1.4cm,采用腔镜下钬激光狭窄段内切开治疗。术后留置尿管2～4周。拔除尿管后根据随访排尿状况定期作尿道扩张。结果 17例病例均取得手术成功,手术时间30～90min,平均40min,术后排尿显著改善,最大尿流率(Qmax)由术前平均6.5(2.8～11.5)ml/s提高到术后20.4(16.6～25.3)ml/s,无尿失禁、阳痿、尿瘘并发症。术后随访3～18个月,均排尿良好,无再狭窄发生,B超检查剩余尿<20ml。结论腔镜下钬激光内切开加定期尿道扩张治疗男性尿道狭窄及闭锁安全有效,近期治疗效果良好,手术创伤小,并发症少,值得推广应用。     

尿道内切开术加电切术治疗尿道狭窄及闭锁(附37例报告)

目的探讨尿道狭窄及闭锁的有效治疗方法。方法回顾性分析37例尿道狭窄患者的临床资料,并比较直视下尿道内切开术和直视下尿道内切开术加电切术的疗效。结果作直视下尿道内切开术16例,一次性治愈7例（43．8％）。作经尿道内切开加电除术2l例,一次性治愈17例（81．0％）。结论内窥镜直视下尿道内切开加电切术具有损伤少,恢复快,术后并发症少和复发率较低。因此,它是目前治疗尿道狭窄的有首选方法。