摘要
目的探讨近10年单中心男性尿道狭窄病因及治疗方法的变化趋势。方法收集北京积水潭医院泌尿外科2013年1月—2022年12月收治的940例男性尿道狭窄患者,按照收治时间将患者分别纳入2013—2017年组及2018—2022年组,对比分析两组患者的病因、狭窄部位及长度和治疗方式。结果940例男性尿道狭窄的病因分别为外伤447例(47.55%)、医源性损伤220例(23.40%)、特发性病因128例(13.62%)、硬化性苔藓样变78例(8.30%)、感染46例(4.89%)、其他病因21例(2.23%)。治疗方法分别为尿道成形术691例(73.51%)、尿道狭窄内切开122例(12.98%)、尿道扩张86例(9.15%)、耻骨上膀胱造瘘41例(4.36%)。前后5年对比分析显示,2018—2022年组外伤所致尿道狭窄的占比较2013—2017年组明显下降(41.71%vs.60.34%,P<0.001),而医源性损伤所占比例明显上升(26.05%vs.17.63%,P=0.005);2018—2022年组尿道成形术占比有所增多(75.66%vs.68.81%,P=0.027),尿道狭窄内切开术的应用占比显著下降(9.92%vs.19.66%,P<0.001);2018—2022年组与2013—2017年组比较,膜部尿道狭窄所占比例显著下降(26.98%vs.50.85%,χ^(2)=51.06,P<0.001),而阴茎段尿道狭窄(21.40%vs.7.80%,χ^(2)=26.37,P<0.001)及尿道外口狭窄(9.30%vs.4.75%,χ^(2)=5.80,P<0.001)所占比例明显增多。结论外伤是近10年男性尿道狭窄的主要原因,但占比呈下降趋势;医源性损伤已上升为男性尿道狭窄的第2大原因;采用尿道成形术治疗的患者比例显著增多,成为近5年男性尿道狭窄最主要的治疗方法。
Objective To investigate the changing trends in etiology and treatment of male urethral stricture in recent 10 years.Methods A total of 940 male patients with urethral stricture admitted to the Department of Urology of Beijing Jishuitan Hospital during Jan.2013 and Dec.2022 were continually collected.The clinical data were divided into two groups according to the time of admission,namely the group from 2013 to 2017 and the group from 2018 to 2022,for a comparative analysis of the previous and subsequent 5 years.The etiology,location,length and the type of treatment of urethral stricture were retrospectively analyzed.Results The causes of the 940 cases of male urethral stricture were trauma in 447(47.55%),iatrogenic injury in 220(23.40%),idiopathic causes in 128(13.62%),lichen sclerosus(LS)in 78(8.30%),infection in 46(4.89%),and other causes in 21(2.23%).The treatment methods were urethroplasty in 691(73.51%),direct vision internal urethrotomy(DVIU)in 122(12.98%),urethral dilatation in 86(9.15%),and suprapubic cystostomy in 41(4.36%).Compared with the previous 5 years,in the past 5 years,the proportion of urethral stricture caused by trauma decreased significantly(60.34%vs.41.71%,P<0.001),while the proportion of iatrogenic injury increased significantly(17.63%vs.26.05%,P=0.005).In the past 5 years,the proportion of urethroplasty increased from 68.81%to 75.66%(P=0.027),while the proportion of DVIU decreased from 19.66%to 9.92%(P<0.001).In the past 5 years,the proportion of membranous urethral stenosis decreased significantly(26.98%vs.50.85%,χ^(2)=51.06,P<0.001),the proportion of penile urethral stricture(21.40%vs.7.80%,χ^(2)=26.37,P<0.001)and meatal stenosis(9.30%vs.4.75%,χ^(2)=5.80,P<0.001)increased significantly.Conclusion In the past decade,trauma was the main cause of male urethral strictures,but its proportion showed a decreasing trend.Iatrogenic injury led to a gradual increase in urethral strictures,which was the second leading cause of male urethral stricture.The application of urethroplasty increased significantly,making it the main treatment method for male urethral stricture.
作者
夏海缀
翟建坡
王建伟
李贵忠
黄广林
满立波
XIA Haizhui;ZHAI Jianpo;WANG Jianwei;LI Guizhong;HUANG Guanglin;MAN Libo(Department of Urology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100096,China)
出处
《现代泌尿外科杂志》
CAS
2024年第9期797-802,共6页
Journal of Modern Urology
关键词
尿道狭窄
男性
外伤
医源性损伤
尿道成形术
尿道狭窄内切开术
urethral stricture
male
trauma
iatrogenic injury
urethroplasty
direct vision internal urethrotomy
