摘要
目的 比较尿道球囊扩张术与尿道探条扩张术治疗男性尿道狭窄的临床疗效.方法 选取2017年2月至2023年9月北京大学第一医院收治的101例男性尿道狭窄患者进行回顾性分析,按照不同手术方法分为两组,55例行尿道球囊扩张术患者为球囊组,46例行尿道探条扩张术患者为探条组.通过查阅电子病历、门诊、电话随访等方式,收集患者基本信息,并对患者术后并发症和狭窄复发情况进行随访.终点事件设置为需要医疗干预的术后尿道狭窄复发,干预手段包括导尿、耻骨上膀胱造瘘、尿道腔内治疗、尿道成形术等.比较两组临床疗效及影响疗效的危险因素.结果 两组年龄、身高、体质量、体质量指数、术前白蛋白、白细胞、血红蛋白、尿道狭窄部位、是否为再次手术比较,差异无统计学意义(P＞0.05);球囊组术前合并尿路感染率、医源性尿道狭窄率、狭窄段长度≥2 cm比例、多发尿道狭窄率均高于探条组,差异有统计学意义(P＜0.05).两组术后并发症发生率比较(14.55％vs.30.43％),差异无统计学意义(P＞0.05).随着时间推移,两组尿道狭窄手术有效率差异呈现逐渐显著趋势,差异有统计学意义(HR=0.42,95％CI0.20～0.87,P=0.02).对于术前合并尿路感染的尿道狭窄患者,球囊组手术有效率更高,差异有统计学意义(HR=0.39,95％CI0.18～0.86,P=0.02).无论是否为医源性尿道狭窄,两种手术方法疗效相当,差异无统计学意义(P＞0.05).对于狭窄段长度＜2 cm的尿道狭窄,两种手术方式疗效相当,差异无统计学意义(P＞0.05);对于狭窄段长度≥2 cm的尿道狭窄,球囊组手术有效率更高,差异有统计学意义(HR=0.18,95％CI 0.06～0.54,P=0.002).对于首次手术干预的尿道狭窄,两组疗效相当,差异无统计学意义(P＞0.05);对于需再次手术干预的尿道狭窄,球囊组手术有效率更高,差异有统计学意义(HR=0.30,95％CI0.12～0.75,P=0.01).患者术前是否合并尿路感染、是否首次手术治疗、尿道狭窄的病因、狭窄部位、狭窄段长度、是否为多发尿道狭窄对其预后无明显影响(P＞0.05),与尿道探条术比较,球囊扩张术是降低术后复发率的独立保护性因素(HR=0.42,95％CI0.20～0.88,P=0.02).结论 医源性尿道损伤是尿道狭窄的重要原因.与尿道探条扩张术比较,球囊扩张术的狭窄复发率较低,但远期疗效仍需进一步随访观察.尿道球囊扩张术与探条扩张术均有较高的安全性,两种术式在并发症方面无明显差异.与尿道探条术比较,球囊扩张术是降低术后复发率的独立保护性因素.
Abstract
Objective To compare the clinical efficacy of urethral balloon dilatation and probe strip dilatation for male patients with urethral stricture.Methods A total of 101 male urethral stricture patients admitted to Peking University First Hospital from February 2017 to September 2023 were retrospectively analyzed and divided into two groups according to the surgical methods,including 55 patients of the balloon group who underwent urethral balloon dilatation and 46 patients of the probe strip group who underwent urethral probe strip dilatation.The basic information of the patients was collected by checking the electronic medical records as well as outpatient or telephone follow-up,and the patients were followed up for postoperative complications and recurrence of stenosis.The endpoint event was set as postoperative urethral stricture recurrence requiring medical intervention,which included catheterization,suprapubic cystostomy,urethral endoluminal therapy and urethroplasty.The relevant data were statistically analyzed to compare the clinical efficacy of the two surgical modalities and the risk factors affecting the efficacy.Results The basic clinical data of the two groups of patients,such as age,height,body mass,body mass index,preoperative albumin,preoperative blood leukocytes,preoperative blood hemoglobin,site of urethral stenosis,and reoperation rate,were compared and analyzed,and the results showed that there was no statistical significance in the difference between the two groups(P＞0.05).The preoperative combined urinary tract infection rate,medical urethral stenosis rate,the proportion of stenosis segment length ≥2 cm,and multiple urethral stenosis rate of the balloon group were higher than those of the probe strip group,and the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of postoperative complications between the two groups(14.55％vs.30.43％)(P＞0.05).The difference in the surgical efficiency of urethral stricture between the two groups showed a trend of gradual significance,with a statistically significant difference(HR=0.42,95％CI 0.20-0.87,P=0.02).For patients with urethral stricture who had preoperative coexisting urinary tract infections,the surgical efficiency in the balloon group was higher,with a statistically significant difference(HR=0.39,95％CI 0.18-0.86,P=0.02).Regardless of whether the urethral stenosis was of medical origin or not,the efficacy of the two surgical methods was comparable and the difference was not statistically significant(P＞0.05).For urethral strictures with a stenotic segment length of＜2 cm,the efficacy of the two surgical approaches was comparable and the difference was not statistically significant(P＞0.05);for urethral strictures with a stenotic segment length of ≥2 cm,the surgical efficacy was higher in the balloon group,and the difference was statistically significant(HR=0.18,95％CI 0.06-0.54,P=0.002).For urethral strictures requiring first surgical intervention,the efficacy of the two groups was comparable,and the difference was not statistically significant(P＞0.05);for urethral strictures requiring re-surgical intervention,the surgical efficacy rate was higher in the balloon group,and the difference was statistically significant(HR=0.30,95％CI 0.12-0.75,P=0.01).The combined urinary tract infection,first surgical treatment,the cause of urethral stricture,the location of stricture,the length of stricture,and multiple urethral strictures had no significant effect on the prognosis of the patients(P＞0.05),and balloon dilatation was an independent protective factor to reduce the postoperative recurrence rate compared with urethral probe strip surgery(HR=0.42,95％CI 0.20-0.88,P=0.02).Conclusions Iatrogenic urethral injury is an important cause of urethral stricture.Compared with urethral probe strip dilatation,balloon dilatation has a lower recurrence rate of stricture,but further follow-up observation is still needed for long-term efficacy.Both urethral balloon dilatation and probe strip dilatation have a high degree of safety,and there is no significant difference in complications between the two procedures.Balloon dilatation was an independent protective factor in reducing postoperative recurrence rates compared with urethral probe strip dilatation.
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