Clinical study on ureteroscope, holmium laser combined with fascial dilator in the treatment of recurrent urethral stricture / 中国基层医药

ABSTRACT

Objective:To explore the clinical effects of ureteroscopic holmium laser urethrotomy combined with fascial dilator urethral dilatation in the treatment of recurrent urethral stricture.Methods:The clinical data of 62 patients with recurrent urethral stricture in the Third People′s Hospital of Datong from October 2016 to September 2018 were retrospectively analyzed.The patients were divided into two groups according to the treatment method.The control group( n=28) underwent ureteroscopic holmium laser urethrotomy, and the combined group( n=34) underwent ureteroscopic holmium laser urethrotomy combined with fascial dilator urethral dilatation.The urodynamic parameters[maximum urinary flow rate(Qmax), residual urine volume(RUV), Abrams-Griffiths(AG)value], lower urinary tract symptoms[International Prostate Symptom Score(IPSS)], erectile function[International Index of Erectile Function-5(IIEF-5)] and sexual life quality[Sexual Life Quality Questionnaire(SLQQ)] were compared between the two groups before surgery and at 6 months after surgery.The perioperative basic indicators and incidence rate of complications and recurrence rate of urethral stricture within 6 months after surgery were analyzed in the two groups. Results:At 6 months after surgery, the Qmax, scores of IIEF-5 and SLQQ in the control group were (19.18±4.67)mL/s, (15.23±3.94)points and (55.69±16.97)points, respectively, which in the combined group were (22.41±4.82)mL/s, (17.54±3.72)points and (64.31±15.80)points, respectively, and the indicators in the two groups were significantly increased compared with before surgery, and the indicators in the combined group were significantly higher than those in the control group( t=2.406, 2.135, 2.208, all P<0.05). The RUV, AG value and IPSS score in the control group were (11.75±3.24)mL, (36.09±7.86) and (13.80±4.18)points, respectively, which in the combined group were (9.46±2.89)mL, (30.58±7.27) and (11.34±3.65)points, respectively, and the indicators in the two groups were significantly decreased compared with before surgery, the indicators in combined group were significantly lower than those in control group( t=2.637, 2.573, 2.216, all P<0.05). The operative time, intraoperative blood loss, gross hematuria duration, hospital stay and catheter indwelling time in the combined group were (35.10±10.26)min, (12.15±2.06)mL, (18.61±5.19)h, (4.72±1.25)d and (14.46±3.20)d, respectively, which were significantly shorter or lower than those in the control group [(44.12±11.95)min, (13.64±2.80)mL, (22.62±5.76)h, (5.81±1.43)d and (27.93±4.48)d] ( t=2.863, 2.143, 2.586, 2.869, 3.151, all P<0.05). Within 6 months after surgery, the incidences of local hematoma, rectal injury and recurrence rate of urethral stricture in the combined group were 2.94%(1/34), 0.00%(0/34) and 5.88%(2/34), respectively, which were significantly lower than those in the control group [25.00%(7/28), 21.43%(6/28) and 28.57%(8/28)] (χ 2=4.830, 5.801, 4.286, all P<0.05). Conclusion:Ureteroscopic holmium laser urethrotomy combined with fascial dilator urethral dilatation can effectively improve the lower urinary tract symptoms in patients with recurrent urethral stricture.And it has few complications and low recurrence rate, and can improve sexual life quality of patients.