Application of laparoscopy in complicated posterior urethral stricture
ZHU Desheng1, WU Haixiao1, XU Min1, WU Han1, YANG Qing2, MA Min3, ZHANG Xu1, XU Danfeng1, LV Guanghong1, LI Yingru1
1 Department of Urology, Jinhua Municipal Central Hospital, Jinhua 321000, China; 2 Department of Urology ,Chinese PLA General Hospital; 3 Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Abstract:Objective: To investigate the efficacy and safety of laparoscopy in treating complicated posterior urethral stricture. Methods: The clinical data of 26 patients with complex posterior urethral stricture from September 2014 to September 2017 were analyzed retrospectively. Results: All the 26 patients completed the operation successfully. The operation time was (160±55) min (130-230 min). The hospitalization was (7.6±1.4) d (3-11 d) after operation. The urethral catheter was removed 2 weeks after the operation. All patients were followed-up for 18 months(7-36 months) after the operation, and no case was lost. After extubation, the urination was unobstructed in 24 cases. The maximum urine flow rate was (19.0±4.6) mL/s. Urinary retention occurred in 1 case after removal of urethral catheter. After 4 weeks, the catheter was removed again and urethral dilatation was regularly performed for 6 weeks. The voiding patency rate and maximum urine flow rate were 15.6 mL/s after 6 months. One case had membranous urethral stricture 3 months after extubation. After cold-knife internal urethrotomy the urination was unobstructed. Conclusion: laparoscopy can be used of minimally invasive treatment of posterior urethral stricture safely and reliably. Combined with open surgery for posterior urethral stricture, the operation can achieve less trauma and restenosis. It is an effective measure in treating posterior urethral stricture, and could be widely used in clinical.
[1] 蔡建良,夏溟,宋玉峰,等.男性长段尿道狭窄的经尿道腔内治疗分析(附12例报告).微创泌尿外科杂志,2014,3(3):178-180. [2] FU Q, ZHANG J, SA YL, et al.Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre. BJU Int, 2013,112(4):E358-E363. [3] COOPERBERG MR, MCANINCH JW, ALSIKAFI NF, et al.Urethral Reconstruction for traumatic posterior urethral disruption:outcomes of a 25-year experience. J Urol, 2010,178(5):2006-2010. [4] ZAID UB, LAVIEN G, PETERSON AC.Management of the recurrent male urethral stricture. Curr Urol Rep, 2016,17(4):33. [5] HORIGUCHI A, SHINCHI M, MASUNAGA A, et al.Do transurethral treatments increase the complexity of urethral strictures? J Urol, 2018,199(2):508-514. [6] ISONO M, HORIGUCHI A, TASAKI S,et al.The efficacy of direct vision internal urethrotomy for male urethral stricture. Nihon Hinyokika Gakkai Zasshi, 2012,103(6):691-696. [7] PODESTA M, PODESTA J.Delayed surgical repair of posttraumatic posterior urethral distraction defects in children and adolescents: Long-term results. J Pediatr Urol, 2015,11(2):61-67. [8] FU Q, XU YM, ZHANG J, et al.Use of anastomotic urethroplasty with partial pubectomy for posterior urethral obliteration injuries: 10 years experience. World J Urol, 2009,27(5):695-699. [9] GUPTA NP, MISHRA S, DOGRA PN, et al.Does a previous end-to-end urethroplasty alter the results of redo end-to-end urethroplasty in patients with traumatic posterior urethral strictures? Int J Urol, 2008,15(10):885-888. [10] PRATAP A, AGRAWAL CS, TIWARI A, et al.Complex posterior urethral disruptions: Management by combined abdominal transpubic perineal urethroplasty. J Urol, 2006,175(5):1751-1754. [11] SIEGEL JA, PANDA A, TAUSCH TJ, et al.Repeat excision and primary anastomotic urethroplasty for salvage of recurrent bulbar urethral stricture. J Urol, 2015,194(5):1316-1322. [12] STRITTMATTER F, BECK V, STIEF CG, et al.Urethral stricture : From diagnostics to appropriate treatment. Urologe A, 2017,56(8):1047-1057. [13] 王滨帅,黄毅,马潞林.根治性前列腺切除术后控尿功能恢复的危险因素分析.中华泌尿外科杂志,2017,38(12):932-936.