经尿道前列腺电切术后尿道狭窄的原因及防治

目的探讨经尿道前列腺电切术（transurethral resection of prostate,TURP）术后尿道狭窄的原因及防治方法。方法回顾性分析2002年2月-2008年2月945例TURP中21例（2.2%）尿道狭窄的临床资料。年龄62-84岁,平均72.4岁。尿道狭窄发生时间为术后3周-24个月。前尿道狭窄13例（61.9%）,后尿道狭窄5例（23.8%）,膀胱颈挛缩3例（14.3%）。结果单纯尿道扩张治愈13例（61.9%）,尿道口成形2例（9.5%）,尿道口成形联合尿道扩张2例（9.5%）,经尿道内切开1例（4.8%）,再次行膀胱颈电切3例（14.3%）。随访6-36个月,平均13个月,21例均治愈,无复发。开展手术初期（2002年2月-2005年8月）尿道狭窄发生率3.7%（18/483）,后期发生率0.6%（3/462）（χ^2=10.292,P=0.001）。结论术中操作不熟练,术后留置尿管时间短,是导致此并发症发生的原因。术后定期随访和早期治疗是治愈的关键。

Causes and Prevention of Urethral Stricture after Transurethral Resection of the Prostate

Objective To investigate the causes and prevetion of urethral stricture after transurethral resection of the prostate （TURP）. Methods A retrospective analysis was carried out in 945 cases, who were treated by TURP in our hospital during February 2002 - February 2008. Among the cases, 21 patients （ aged 62 to 84 years with a mean of 72.4 years） developed urethral stricture in 3 weeks to 24 months after the operation. In the cases, anterior urethral stricture was detected in 13 patients （61.9%） , posterior urethral stricture was found in 5 （23.8%）, and bladder neck contracture was diagnosed in 3 （ 14.3% ）. Results The pateints were cured by simple urethral dilation （13, 61.9% ）, urethroplasty （2, 9.5% ）, urethroplasty plus urethral dilation （2, 9.5% ）, transurethral resection （ 1, 4. 8% ）, or eleetroresection of the bladder neck （3, 14.3% ）. The patients were followed up for 6 to 36 months （mean, 13 months） , during which, all the 21 cases recovered without recurrence. The rate of urethral stricture after TURP was 3.7% （18/483） during February 2002 to August 2005, which was significantly higher than that between September 2005 and February 2008 （0.6% , 3/462; χ^2 = 10. 292, P = 0. 001 ）. Conclusions Unskilled operation and short indwelling time of urethral catheter after the surgery are the major reasons for urethral stricture after TURP. Regular follow-up and early treatment are the keys to cure of the disease.