女性尿道综合征经尿道膀胱颈部电切手术治疗探讨

目的 探讨手术治疗在女性尿道综合征治疗中的临床意义.方法 经尿道膀胱颈部电切术加尿道外口成形术,治疗严重女性尿道综合征患者46例.结果 其中45例患者术后随访11个月～2.5年,40例症状完全消失,4例症状改善,1例症状改善不明显.结论 经尿道膀胱颈部电切术加尿道外口成形术,治疗女性尿道综合征效果明显.     

尿道综合征的病理表现和病因探讨(附20例报告)

女性尿道综合征是泌尿科常见疾病。患者有尿频、尿急、尿疼和尿道烧灼感反复发作,但尿常规正常,中段尿培养阴性,统称为尿道综合征。近年研究表明,本征并非一种单独疾病,而是不同原因所引起的多种疾病所共同的症状群。其病因复杂,至今尚未彻底阐明。我院自1982年以来对20例因尿道综合征作了尿道前庭移植术的患者进行了尿道口组织病理检查,现报告如下。试图从     

手术治疗女性尿道综合征30例回顾分析

目的探讨女性尿道综合征在手术治疗上的临床意义。方法阴道前庭成形术加尿道外口成形术,将尿道口和阴道口之间弧形切开,尿道外口后唇切开,切口纵行缝合,使尿道外口与阴道口拉开距离,恢复正常的阴道前庭,消除尿道外口狭窄现象,恢复正常排尿。结果30例患者术后随访6个月～2年,28例症状完全消失,2例明显改善。结论手术治疗女性尿道综合征效果明显,除非合并膀胱颈纤维化,手术治疗作用有效。     

尿道口处女膜融合症的诊治（附56例报告）

尿道外口解剖异常是女性尿道综合征发病原因之一，常见为处女膜融合，可发生于任何年龄女性，以中老年女性发病率最高。主要表现为尿频、尿急、尿痛、下腹部坠胀及尿道疼痛等。药物治疗及尿道扩张效果不佳，且反复发作，久治不愈。我院1997年6月至2007年6月共收治尿道口处女膜融合症56例，报告如下。     

整形手术治疗女性尿道口畸形39例

目的探讨尿道口处女膜整形手术治疗女性尿道口处女膜畸形的效果. 方法本组39例,均发现尿道口处女膜融合或处女膜伞形成,表现为以尿频为主的尿道综合征.均经尿常规、尿培养和尿流动力学检查确诊.局部麻醉或骶管麻醉,行尿道口处女膜间横行切开,纵行缝合,恢复尿道口处女膜正常解剖. 结果全部手术成功,随访3个月～4年,近远期效果良好. 结论整形手术是治疗女性尿道口处女膜畸形,解除尿道综合征的一种有效方法,具有方法简单,创伤小,痛苦少,恢复快,效果好等优点,适用于泌尿外科及妇科临床.     

女性尿道综合征31例临床治疗分析

目的 探讨女性尿道综合征的治疗效果。方法 31例患者，其中21例进行了尿动力学检查，均有尿动力学异常。治疗上采取心理、行为、药物等方面综合治疗。结果 治疗总有效率为87％。结论 尿动力学检查是女性尿道综合征诊断和治疗依据，女性尿道综合征的治疗应采取综合治疗。     

尿道口—阴道口间距延长术治疗女性尿道综合征的体会

尿道综合征是指有下尿路刺激症状而无明显器质性变及菌尿的一组征候群 ,多见于女性。病因复杂 ,临床治疗较为棘手。尿道口 -阴道口间距过短是女性尿道综合征的病因之一。我院自 1995年至 2 0 0 0年采用尿道口 -阴道口间距延长术治疗女性尿道综合征 12例 ,疗效满意 ,报告如下。临床资料一、一般资料 :本组 12例 ,年龄 2 6～ 5 2岁 ,平均 42 .5岁 ,均有婚育史。病程 3～ 36个月 ,平均 11个月。临床上均有程度不等的尿急、尿频、尿痛等症状。伴排尿不畅的有 4例 ,性交后症状加重者 5例。局部检查 ,尿道口 -阴道口间距为 0 .3ｃｍ者 3例 ,余均小…     

水气合剂超声造影在女性尿道憩室诊治中的意义

目的探讨水气合剂超声造影在女性尿道憩室诊治中的意义并复习女性尿道憩室的临床特点、诊断及治疗方法。方法对8例女性尿道憩室患者的临床资料进行回顾性分析。结果本组患者临床表现为排尿后尿道口漏尿(4例)、腹压增加和行走时偶有漏尿(2例)、尿频尿急尿痛(2例)、尿道口流脓(2例)、尿道口占位(1例)、会阴部疼痛(1例)、合并尿路感染2例。入院前6例被误诊,分别诊断为尿失禁、泌尿系感染、尿道旁腺囊肿、尿道口囊肿和尿道旁脓肿,后均通过阴道B超引导下尿道注水、注气造影得到确诊,术中切除尿道憩室后治愈,无并发症发生。随访1～2年憩室无复发。结论女性尿道憩室临床表现多样,极易误诊。阴道B超引导下尿道注水、注气造影是诊断女性尿道憩室的一种新的可靠方法,经阴道尿道憩室切除术是治疗该病的有效手段。     

尿动力学检查在女性尿道综合征的应用（附160例分析报告）

为探讨尿动力学检查(UDS)在女性尿道综合征(FUS)的临床价值,应用Laborie公司Encore 5.7尿动力分析仪检查FUS160例。结果发现剩余尿>50ml者占34.4％,初尿意尿量<60ml者28.1％,60～100ml者25.4％,由于有剩余尿和产生初尿意的尿量较少,产生初尿意的实际增加尿量更少,这些都可能是产生尿道综合征症状的部分原因。本组膀胱逼尿肌收缩无力或减弱55例,占34.4％,单纯使用平滑肌兴奋剂,如新斯的明和加兰他敏等提高了疗效。认为尿动力学检查女性尿道综合征患者,有助于了解其病因,分类治疗能提高疗效。     

坦索罗辛治疗女性尿道综合征(附63例报告)

女性尿道综合征 (ＦＵＳ)是以下尿路刺激症状或排尿困难为主要表现 ,病程迁延且治疗困难的一组常见症候群。我们用坦索罗辛 (哈乐 )治疗 6 3例患者 ,疗效满意 ,报告如下。1　　 资料与方法1 .1 　 临床资料1 998年 3月～ 2 0 0 0年 1 1月用坦索罗辛治疗74例女性尿道综合征 ,1 1例失随访。 6 3例获随访的患者中最小 1 6岁 ,最大 6 9岁 ,平均 3 6 .5岁。病程 4个月～ 1 7年 ,平均 4.8年。绝大多数患者经过多次抗生素、普鲁苯辛等治疗效果不佳。尿动力学检查 ,不稳定膀胱 43例 (6 8.3 %) ,有尿道压增高者3 2例 (5 0 .8%) ,其中有 7例尿道压增高…     

A Systematic Review of Surgical Techniques Used in the Treatment of Female Urethral Stricture

Context

Female urethral stricture (FUS) is a rare and challenging clinical entity. Several new surgical techniques have been described for the treatment of FUS, although with the limited number of reports, there is no consensus on best management.

Objective

We evaluated the evidence for surgical interventions reported for treating FUS.

Evidence acquisition

We performed a systematic review of the PubMed and Scopus databases, classifying the results by surgical technique and type of graft in the case of graft augmentation urethroplasty.

Evidence synthesis

A total of 221 patients have been reported on with outcome measures after intervention for FUS. The mean age of women was 51.8 yr of age (range: 22–91). All studies were retrospective case series. There was no consistent definition of FUS nor unified diagnostic criteria. Most studies used a combination of diagnostic tests. Where aetiology was defined, idiopathic and iatrogenic stricture were the two most common causes. Ninety-eight patients underwent prior intervention for FUS, mostly urethral dilatation or urethrotomy. Success was defined as the lack of need for further intervention. Urethral dilatation, assessed in 107 patients, had a mean success rate of 47% at a mean follow-up of 43 mo. Fifty-eight patients had vaginal or labial flap augmentation, with a mean success rate of 91% at 32.1 mo of mean follow-up. Vaginal or labial graft augmentation had a mean success rate of 80% in 25 patients at a mean follow-up of 22 mo. Oral mucosal augmentation, performed in 32 patients, had a mean success rate of 94% at 15 mo of mean follow-up. No instances of de novo stress incontinence were reported.

Conclusion

The techniques of urethroplasty all have a higher mean success rate (80–94%) than urethral dilatation (<50%), although with shorter mean follow-up. Urethroplasty in experienced hands appears to be a feasible option in women who have failed urethral dilatation, although there is a lack of high-level evidence to recommend one technique over another.     

结肠黏膜尿道成形治疗复杂性超长段尿道狭窄的长期疗效

目的 观察结肠黏膜尿道成形术治疗复杂性超长段尿道狭窄的长期效果和影响因素. 方法 2000年10月至2009年9月采用结肠黏膜尿道成形治疗复杂性超长段尿道狭窄46例.年龄17 ～70岁,平均39岁.尿道狭窄段长10.0～20.0 cm,平均15.2 cm.术前有平均2.7次不成功的尿道修复史.通过定期门诊或电话随访进行术后疗效评估,包括排尿情况和尿流率检查,部分患者行尿道造影和尿道镜检查等.以不需要任何处理包括尿道扩张,能正常排尿,尿流率在正常范围内者视为手术成功. 结果 结肠黏膜重建尿道的长度为11.0～21.0 cm,平均15.4 cm.1例失访,余45例随访20～120个月,平均62个月.发生与手术相关的并发症4例(8.9％),其中3例于术后3、8和24个月发生尿道外口狭窄,1例术后29个月发生结肠黏膜新尿道与尿道近端吻合口狭窄.另2例发生与结肠黏膜尿道成形术无关的尿道狭窄. 结论 结肠黏膜尿道成形术治疗复杂性超长段尿道狭窄术后长期效果理想;影响术后效果的因素是尿道口狭窄和吻合口狭窄.     

斑马导丝引导下尿道扩张治疗尿道狭窄28例分析

目的探讨在斑马导丝引导下应用筋膜扩张器或S形尿道扩张器行尿道扩张治疗尿道狭窄的临床效果。方法回顾性分析28例在斑马导丝引导下应用筋膜扩张器或S形尿道扩张器行尿道扩张治疗尿道狭窄病例的临床资料。结果 26例患者采用该种方法行尿道扩张成功,规律行尿道扩张8月后23例排尿通畅,最大尿流率大于15mL/s;3例患者仍排尿不畅,予以开放手术治疗。未成功的2例中,1例因尿道狭窄情况复杂而未能置入斑马导丝;1例患者置入斑马导丝后置入扩张器时阻力过大,无法通过;这2例患者均择期改行尿道成形术。26例扩张成功的患者无明显并发症。结论在斑马导丝引导下尿道扩张治疗尿道狭窄的方法具有损伤小、效果好、安全等优点,适用于传统尿道扩张失败的患者。     

Endoscopic urethroplasty with unseeded small intestinal submucosa collagen matrix grafts: a pilot study

PURPOSE: We evaluated small intestinal submucosa (SIS) as a substitute for skin in endoscopic urethroplasty performed as treatment for inflammatory and iatrogenic strictures of the male bulbar urethra, and in the early treatment of bulbomembranous urethral injuries associated with recent pelvic fractures. Tissue integration and epithelialization of SIS in endoscopic urethroplasty were assessed, as was the long-term maintenance of urethral patency following this treatment. MATERIALS AND METHODS: Nine patients with bulbar urethral strictures defined by urethrography were enrolled in the study. Following optical urethrotomy the SIS grafts were tubularized over a purpose specific graft carrying balloon device and secured into the opened urethra as described for endoscopic urethroplasty. Patients were followed with urethroscopy and urethrography at regular intervals as per protocol or when symptoms arose. Failure was defined as the need for any further intervention. RESULTS: Two patients with short inflammatory strictures maintained urethral patency without any intervention at 1 and 2 years, respectively. Stricture recurrence developed in 6 patients within 3 months of surgery. Of these, 3 have undergone subsequent open urethroplasty, 2 are currently awaiting urethroplasty and 1 is maintaining urethral patency with regular self-dilatation. One patient was lost to followup. CONCLUSIONS: Endoscopic urethroplasty with unseeded SIS grafts was unsuccessful in this study.     

游离黏膜尿道成形治疗硬化性苔藓样病所致尿道狭窄的疗效观察

目的 提高对硬化性苔藓样病( lichen sclerosus,LS)导致尿道狭窄的认识,观察游离黏膜尿道成形治疗LS所致尿道狭窄的疗效. 方法 2007年1月-2010年12月收治LS所致前尿道狭窄患者36例,年龄27～75岁,平均41岁.尿道狭窄段长5.0 ～20.0 cm,平均11.5 cm.根据尿道狭窄段长短和严重程度选择不同的黏膜组织,其中行口腔内黏膜(舌、颊黏膜)尿道成形27例,结肠黏膜尿道成形8例,另1例老年患者行前尿道劈开.在行尿道重建术前对病变累及的阴茎头、尿道口、尿道行病理学检查. 结果 36例患者术后3周拔除导尿管,排尿通畅;活检结果提示上皮基底部特征性病变,过度角化,上皮层变薄,淋巴细胞浸润等.术后随访6 ～ 50个月,平均22个月.出现尿道外口狭窄3例(8.3％),其中口腔内黏膜尿道成形者2例,结肠黏膜重建尿道者1例,行尿道外口切开后排尿通畅.余患者术后排尿通畅,最大尿流率17.2～47.0 ml/s,平均23.4 ml/s. 结论 采用游离黏膜尿道成形治疗LS所致尿道狭窄疗效较好,但需密切随访,因病变迁延可致尿道再狭窄,尤其是尿道口再狭窄.     

REPEAT URETHROTOMY AND DILATION FOR THE TREATMENT OF URETHRAL STRICTURE ARE NEITHER CLINICALLY EFFECTIVE NOR COST-EFFECTIVE

PURPOSE: We developed an algorithm for the management of urethral stricture based on cost-effectiveness. MATERIALS AND METHODS: United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132). RESULTS: The costs were urethrotomy/urethral dilation 2,250.00 pounds sterling (3,375.00 dollars, ratio 1.00), simple 1-stage urethroplasty 5,015.00 pounds sterling (7,522.50 dollars, ratio 2.23), complex 1-stage urethroplasty 5,335.00 pounds sterling (8,002.50 dollars, ratio 2.37) and 2-stage urethroplasty 10,370 pounds sterling (15,555.00 dollars, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was 6,113 pounds sterling (9,170 dollars). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by urethroplasty for recurrence yielded a total cost per patient of 5,866 pounds sterling (8,799 dollars). CONCLUSIONS: A strategy of initial urethrotomy or urethral dilation followed by urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.     

The treatment of sphincter strictures

A group of 25 patients with strictures of the membranous urethra following transurethral resection of the prostate (TURP) were investigated and treated initially by careful urethral dilatation. This controlled the stricture in 14 patients, 6 of whom continued with occasional dilatation or self-catheterisation to maintain control; 8 required an artificial urinary sphincter (AUS) and 2 required a "clam" ileocystoplasty for detrusor instability. Eleven had persistent or recurrent strictures requiring urethroplasty. Nine underwent bulbo-prostatic anastomotic urethroplasty, 4 with simultaneous bladder neck reconstruction and 5 with subsequent implantation of an AUS; 2 had a preputial patch urethroplasty with subsequent implantation of an AUS. Four of the 9 patients with a urethroplasty and an AUS are satisfactory, 1 developed a recurrent stricture and 2 developed erosions. Two of those with a bulbo-prostatic anastomosis and bladder neck reconstruction are satisfactory and 2 are incontinent. These results were compared with those of 18 other patients who underwent bladder neck reconstruction and 12 who had a urethroplasty in conjunction with an AUS for reasons other than a post-TURP sphincter stricture. The success rate of bladder neck reconstruction was 55% and the success rate of urethroplasty in conjunction with an AUS was 83%, but the main complication of AUS implantation, erosion, was a more serious problem than failure of bladder neck reconstruction. However, the much higher success rate makes AUS implantation a more satisfactory procedure. Surgery should be avoided if at all possible and reliance placed on urethral dilatation.     

Female urethral stricture: a contemporary series

Purpose

To report the etiology, presenting symptoms and outcomes of the different treatments performed in female patients with recurrent urethral stricture.

Materials and methods

Twenty-six patients with refractory LUTS were diagnosed with a urethral stricture. The symptoms, the treatment performed and the outcomes were prospectively recorded. Sixteen patients were treated with a urethroplasty using a buccal mucosal graft (BMG) in 14 cases (54 %) and a vaginal flap in 2 (8 %). Urethral dilatation, optical urethrotomy and meatoplasty were performed in 8 (31 %), 1 (3.8 %) and 1 (3.8 %) patients, respectively.

Results

Strictures were idiopathic in 11 patients (42 %). Previous urethral instrumentation and traumatic vaginal delivery were the commonest causes of urethral stricture (42 and 15 %, respectively). The most frequent symptoms were reduced flow (93 %), detrusor overactivity (50 %) and UTIs (42 %). The stricture was cured in 93 % of patients treated with a BMG urethroplasty and in all the patients in which a vaginal flap urethroplasty was performed. In the same group, the improvement in urethral pain was observed in the 67 and the 88 % of patients were cured from recurrent UTIs. All the patients treated with urethral dilatation needed further dilatations; hence, the cure of the stricture was achieved in none of them. Improvement in urethral pain, UTIs and detrusor activity was not recorded in the latter group.

Conclusion

Urethroplasty in its various forms has demonstrated in the present series the highest cure rate for the treatment of recurrent urethral stricture.

     

尿道下裂尿道成形术后尿道狭窄的处理

目的 探讨尿道下裂尿道成形术后尿道狭窄的病因及治疗方法。方法 对１９８５－１９９８年７７例尿道下裂术后尿道狭窄患者的临床资料进行回顾性分析。结果 单纯尿道扩张９例,治愈２例（２２％）;尿道扩张放钛镍合金支架２２例,治愈１７例（７７％）;狭窄段尿道切开皮肤造瘘２３例,其中１８例行二期尿道成形术,治愈１６例;５例待手术;切开狭窄段同期尿道成形术２３例,治愈１２例。     

Transpublic urethorplasty for membranous urethral strictures

Six patients with traumatic membranous urethral strictures have undergone urethroplasty utilizing the transpubic approach with resection of a wedge of the symphysis pubis. Three patients are free of stricture, 2 required urethral dilatation in the early postoperative period only, and 1 patient requires dilatation every three months. Four patients are completely continent of urine, 1 has mild stress incontinence, and 1 is incontinent because of a neurogenic bladder. This approach provides excellent exposure with minimal morbidity and allows an easy under-vision anastomosis.