Effect of guiding wire method under soft cystoscopy in treatment of urethral stricture caused by acute closed injury of urethral bulb
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摘要: 目的 观察软膀胱镜下导丝法治疗急性尿道球部闭合性损伤所致尿道狭窄的效果。 方法 选取74例急性尿道球部闭合性损伤所致尿道狭窄患者作为研究对象,均采用软膀胱镜下导丝法行尿道扩张治疗。观察患者的手术时间、术中出血量、住院时间、术后留置尿管期间视觉模拟评分法(VAS)评分、拔除尿管6个月后尿道狭窄发生率、扩尿道次数和最大尿流速率以及并发症发生情况。 结果 本组患者中, 70例尿道扩张成功; 2例因膜部和前尿道严重损伤后形成逆向盲腔(假道)或活瓣, 2例因前列腺Ⅲ度增生发生尿道“针孔样”狭窄,反复插入导丝未能通过而尿道扩张失败。本组患者手术时间为(43.93±6.54)min, 术中出血量为(64.34±5.38)mL, 住院时间为(5.36±0.76)d; 术后留置尿管期间VAS评分为(3.98±1.02)分; 拔除尿管后6个月,尿道狭窄发生率为5.41%, 扩尿道次数为(7.15±1.06)次,最大尿流速率为(19.98±2.68)mL/s。本组患者术中及术后6个月均无直肠损伤、膀胱损伤穿孔、真性尿失禁等严重并发症发生,仅1例因尿道黏膜轻微损伤发生少量出血(经止血治疗后停止出血), 2例发生尿道轻微感染(经常规抗感染治疗后感染得到控制)。 结论 软膀胱镜下导丝法治疗急性尿道球部闭合性损伤所致尿道狭窄的效果显著,尿道扩张成功率高,对患者损伤较小,且并发症较少。Abstract: Objective To observe effect of guiding wire method under soft cystoscopy in treatment of urethral stricture caused by acute closed injury of urethral bulb. Methods A total of 74 patients with urethral stricture caused by acute closed injury of the urethral bulb were selected as study objects, the urethral dilatation treatments were performed by the guiding wire method under soft cystoscopy. The operation time, intraoperative blood loss, hospital stay, Visual Analogue Scale(VAS)score during postoperative indwelling catheterization, incidence of urethral stricture 6 months after catheter removal, the times of urethral dilatation, maximum urine flow rate, and complications were observed. Results A total of 70 cases undergoing urethral dilatation were successfully performed, 2 cases formed a retrograde blind cavity(prosthesis)or valve due to severe damage to the membrane and anterior urethra, and 2 cases developed "pinhole-like" stenosis of the urethra due to third-degree prostatic hyperplasia, the guiding wire was repeatedly inserted but failed to pass causing urethral dilatation failure. The operation time of the patients was(43.93±6.54)min, the intraoperative blood loss was(64.34±5.38)mL, and the hospital stay was(5.36±0.76)days, the VAS score during the postoperative indwelling catheter was(3.98±1.02). The incidence of urethral stricture 6 months after removal of the catheter was 5.41%, and the number of urethral dilatation was(7.15±1.06)times, the maximum urine flow rate was(19.98±2.68)mL/s. No serious complications such as rectal injury,bladder injury and perforation, true urinary incontinence occurred during the operation and 6 months after operation, 1 case occurred a small amount of bleeding due to minor damage to the - urethral mucosa(the bleeding was stopped after hemostasis)and 2 cases had a minor urethral infection, and infection was controlled by routine anti-infection treatment. Conclusion The guiding wire method under soft cystoscopy has a significant effect in the treatment of urethral stricture caused by acute closed injury of the urethral bulb. Urethral dilatation has higher success rate, less injury to patients and fewer complications.
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