男性尿道狭窄病因与治疗方式

目的：探讨男性尿道狭窄的病因，分析近年来尿道狭窄治疗策略，并对复杂性病例进行总结。方法： 回顾性分析183例尿道狭窄住院患者资料，包括病因、狭窄部位和长度、治疗策略和相关合并症等。结果：183例 尿道狭窄患者平均年龄为49.7岁，以51~65岁人群居多(38.8%，71/183)；平均病程为64.7个月。外伤性病因占52.4% (96/183)，其中骨盆骨折者占35.5%(65/183)、骑跨伤者占16.9%(31/183)；医源性损伤者占29.5%。后尿道狭窄占 45.9%(84/183)，前尿道狭窄占44.8%(82/183)，多段狭窄有6.6%(12/183)。99例(54.1%)接受了尿道狭窄段切除端端吻合 术； 40例(21.9%)接受腔内手术治疗，包括内窥镜下钬激光、冷刀内切开、内窥镜下电刀瘢痕切除、球囊扩张和尿道 扩张术等。>65岁尿道狭窄患者27例(14.7%)，经尿道前列腺电切术(transurethral resection of the prostate，TURP)术后并 发尿道狭窄的比例达70.4%，显著高于整体样本的发生率(P<0.01)。结论：近3年男性外伤性和医源性尿道狭窄发生率 有所增加。治疗方式从以内窥镜手术为主转变成以尿道成形术为主。

Causes and management for male urethral stricture

Objective: To explore the etiology of male urethral stricture, analyze the therapeutic strategies of urethral stricture, and summarize the complicated cases. Methods: Th e data of 183 patients with urethral stricture were retrospectively analyzed, including etiology, obstruction site, stricture length, therapeutic strategy, and related complications. Results: Th e mean age was 49.7 years, the average course was 64.7 months, and the constituentratio of 51 to 65 years old patients was 38.8% (71/183). The traumatic injury of patients accounted for 52.4% (96/183), in which the pelvic fracture accounted for 35.5% (65/183) and the straddle injury accounted for 16.9% (31/183). There were 54 cases of iatrogenic injury (29.5%). The posterior urethral stricture accounted for 45.9% (84/183), followed by the anterior urethral stricture (44.8%, 82/183) and the stenosis (6.6%, 12/183). A total of 99 patients (54.1%) received the end to end anastomosis, and 40 (21.9%) were treated with intracavitary surgery, such as endoscopic holmium laser, cold knife incision, endoscopic electroknife scar removal, balloon dilation, and urethral dilation. In the patients over 65-years old, the urethral stricture rate was 14.8% and the complication rate (70.4%) for transurethral resection of the prostate (TURP) was significantly higher than that of all samples (P<0.01). Conclusion: Both the etiology of male urethral stricture and the treatment strategy have changed and the incidence of traumatic and iatrogenic urethral stricture has increased in recent 3 years. The main treatment of urethral stricture has been transformed from endoscopic surgery into urethroplasty.