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。

Antegrade-retrograde endoscopic urethrotomy with holmium laser for treatment of obliterative urethral stricture

Objective To report short-term follow-up on 8 patients with obliterative urethral stricture treated with the antegrade-retrograde urethrotomy with holmium laser. Methods From May 2005 to April 2009, 8 cases of severe urethral stricture underwent antegrade-retrograde endoscopic urethrotomy with holmium laser. The obliterative stricture was 0.8 to 2.5 cm. Results The strictures of all patients were non-passable when using conventional retrograde urethrotomy. The antegrade-retrograde endoscopic urethrotomy were successful in all cases. Urethral catheter (F20-F22) was left in situ for 4-6 weeks. All patients were followed for 6-24 months (mean 18 months) except for one case lost. During the follow-up, 2 patients had no stricture recurrence. Further intermittent urethral dilations (6-16 procedures) or reconstruction with open surgery (3 and 4 months after first treatment) were mandated as stricture recurred in 3 and 2 of 8 patients. Conclusions The antegrade-retrograde endoscopic holmium laser urethrotomy could be a viable and effective option for gaining access across strictures when traditional methods fail. Although all patients could be spared open surgery on first stage treatment, the long-term successful rate of this technique is not satisfied and remains to be evaluated.