摘要：经尿道前列腺电切 （transurethral resection of the prostate，TURP） 术后前尿道狭窄是临床中常见的尿 道狭窄，本文对TURP术后前尿道狭窄流行病学、病因学、处理策略以及预防等进行总结分析。TURP术后前尿 道狭窄的常见部位是舟状窝、阴茎阴囊交界处、尿道球部。TURP术后前尿道狭窄的可能的病因包括机械损伤、 电损伤、感染和留置尿管等。TURP术后前尿道狭窄的治疗一般包括内镜下微创治疗和开放重建手术。内镜下微 创治疗的效果无法保证，尤其是对于长段或严重狭窄的患者，狭窄复发率很高。尿道成形手术包括端端吻合、口 腔黏膜修复、会阴区皮瓣修复和尿道会阴造口等术式。针对TURP术后前尿道狭窄的相关基础和临床研究均较为 匮乏，面对临床上的具体病例，往往是在尿道狭窄处理原则的基础上制定个体化诊疗方案。

暂无相关信息！

[1] RASSWEILER J, TEBER D, KUNTZ R, et al. Complications of transurethral resection of the prostate (TURP)-- incidence, management, and prevention [J]. Eur Urol, 2006, 50(5): 969-979; discussion 980

[2] AUTORINO R, DAMIANO R, DI LORENZO G, et al. Four- year outcome of a prospective randomised trial comparing bipolar plasmakinetic and monopolar transurethral resection of the prostate [J]. Eur Urol, 2009, 55(4): 922-929

[3] MAMOULAKIS C, SCHULZE M, SKOLARIKOS A, et al. Midterm results from an international multicentre randomised controlled trial comparing bipolar with monopolar transurethral resection of the prostate [J]. Eur Urol, 2013, 63(4): 667-676

[4] CORNU JN, AHYAI S, BACHMANN A, et al. A Systematic Review and Meta- analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update [J]. Eur Urol, 2015, 67(6): 1066- 1096

[5] LUMEN N, HOEBEKE P, WILLEMSEN P, et al. Etiology of urethral stricture disease in the 21st century [J]. J Urol, 2009, 182(3): 983-987

[6] LUMEN N, CAMPOS- JUANATEY F, GREENWELL T, et al. European Association of U rology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease [J]. Eur Urol, 2021, 80(2): 190- 200

[7] MAMOULAKIS C, SKOLARIKOS A, SCHULZE M, et al. Results from an international multicentre double- blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate [J]. BJU Int, 2012, 109(2): 240-248

[8] MAMOULAKIS C, TROMPETTER M, DE LA ROSETTE J. Bipolar transurethral resection of the prostate: the 'golden standard' reclaims its leading position [J]. Curr Opin Urol, 2009, 19(1): 26-32

[9] ISSA MM. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP [J]. J Endourol, 2008, 22(8): 1587-1595

[10] MICHIELSEN DP, COOMANS D. Urethral strictures and bipolar transurethral resection in saline of the prostate: fact or fiction [J]. J Endourol, 2010, 24(8): 1333-1337

[11] TANG Y, LI J, PU C, et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and metaanalysis [J]. J Endourol, 2014, 28(9): 1107-1114

[12] KOMURA K, INAMOTO T, TAKAI T, et al. Incidence of urethral stricture after bipolar transurethral resection of the prostate using TURis: results from a randomised trial [J]. BJU Int, 2015, 115(4): 644-652

[13] PARK JK, LEE SK, HAN SH, et al. Is warm temperature necessary to prevent urethral stricture in combined transurethral resection and vaporization of prostate [J]. Urology, 2009, 74(1): 125-129

[14] JAFFE JS, MCCULLOUGH TC, HARKAWAY RC, et al. Effects of irrigation fluid temperature on core body temperature during transurethral resection of the prostate [J]. Urology, 2001, 57(6): 1078-1081

[15] ERTURHAN S, ERBAGCI A, SECKINER I, et al. Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1- year follow- up [J]. Prostate Cancer Prostatic Dis, 2007, 10(1):97-100

[16] GÜNES M, KELES MO, KAYA C, et al. Does resectoscope size play a role in formation of urethral stricture following transurethral prostate resection [J]. Int Braz J Urol, 2015, 41(4): 744-749

[17] MUNDY AR, ANDRICH DE. Urethral strictures [J]. BJU Int, 2011, 107(1): 6-26

[18] FAUL P, SCHLENKER B, GRATZKE C, et al. Clinical and technical aspects of bipolar transurethral prostate resection [J]. Scand J Urol Nephrol, 2008, 42(4): 318-323

[19] DOLUOGLU OG, GOKKAYA CS, AKTAS BK, et al. Impact of asymptomatic prostatitis on re- operations due to urethral stricture or bladder neck contracture developed after TUR-P [J]. Int Urol Nephrol, 2012, 44(4):1085-1090

[20] LATINI JM, MCANINCH JW, BRANDES SB, et al. SIU/ICUD Consultation On Urethral Strictures: Epidemiology, etiology, anatomy, and nomenclature of urethral stenoses, strictures, and pelvic fracture urethral disruption injuries [J]. Urology, 2014, 83(3 Suppl): S1-S7

[21] HOLLINGSWORTH JM, ROGERS MA, KREIN SL, e t al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta- analysis [J]. Ann Intern Med, 2013, 159(6): 401-410

[22] L ISS MA, SKARECKY D, MORALES B, et al. Preventing perioperative complications of robotic- assisted radical prostatectomy [J]. Urology, 2013, 81(2): 319-323

[23] LAM TB, OMAR MI, FISHER E, et al. Types of indwelling urethral catheters for short- term catheterisation in hospitalised adul ts [J ]. C och rane D a tabase Sys t R ev, 2014, 23(9): Cd004013

[24] STEENKAMP JW, HEYNS CF, DE KOCK ML. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison [J]. J Urol, 1997, 157(1): 98-101

[25] BARBAGLI G, FOSSATI N, MONTORSI F, et al. Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis [J]. Eur Urol Focus, 2020, 6(1): 164-169

[26] HEYNS CF, STEENKAMP JW, DE KOCK ML, et al. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful [J]. J Urol, 1998, 160(2): 356-358

[27] HORIGUCHI A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews [J]. Int J Urol, 2017, 24(7): 493-503

[28] BARBAGLI G, GUAZZONI G, LAZZERI M. One- stage bulbar urethroplasty: retrospective analysis of the results in 375 patients [J]. Eur Urol, 2008, 53(4): 828-833

[29] BUGEJA S, ANDRICH DE, MUNDY AR. Non- transecting bulbar urethroplasty [J]. Transl Androl Urol, 2015, 4(1): 41-50

[30] MOREY AF, WATKIN N, SHENFELD O, et al. SIU/ ICUD Consultation on Urethral Strictures: Anterior urethraprimary anastomosis [J]. Urology, 2014, 83 (3 Suppl): S23-S26

[31] BARBAGLI G, DE ANGELIS M, ROMANO G, et al. Long- term followup of bulbar end- to- end anastomosis: a retrospective analysis of 153 patients in a single center experience [J]. J Urol, 2007, 178(6): 2470-2473

[32] SMITH TG, 3RD. Current management of urethral stricture disease [J]. Indian J Urol, 2016, 32(1): 27-33

[33] SIMONATO A, GREGORI A, AMBRUOSI C, et al. Lingual mucosal graft urethroplasty for anterior urethral reconstruction [J]. Eur Urol, 2008, 54(1): 79-85

[34] BARBAGLI G, DE ANGELIS M, ROMANO G, et al. The use of lingual mucosal graft in adult anterior urethroplasty: surgical steps and short- term outcome [J]. Eur Urol, 2008, 54(3):671-676

[35] KULKARNI SB, JOGLEKAR O, ALKANDARI M, et al. Management of post TURP strictures [J]. World J Urol, 2019, 37(4):589-594

[36] WESSELLS H, MCANINCH JW. Current controversies in anterior urethral stricture repair: free- graft versus pedicled skin- flap reconstruction [J]. World J Urol, 1998, 16(3): 175-180

[37] DUBEY D, VIJJAN V, KAPOOR R, et al. Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial [J]. J Urol, 2007, 178(6): 2466-2469

[38] CHAPPLE C, ANDRICH D, ATALA A, et al. SIU/ ICUD Consultation on Urethral Strictures: The management of anterior urethral stricture disease using substitution urethroplasty [J]. Urology, 2014, 83(3 Suppl): S31-S47

[39] ANDRICH DE, MUNDY AR. What is the best technique for urethroplasty [J]. Eur Urol, 2008, 54(5): 1031-1041

[40] BARBAGLI G, DE ANGELIS M, ROMANO G, et al. Clinical outcome and quality of life assessment in patients treated with perineal urethrostomy for anterior urethral stricture disease [J]. J Urol, 2009, 182(2): 548-557

[41] PHAM H, SHARMA P. Emerging, newly- approved treatments for lower urinary tract symptoms secondary to benign prostatic hypertrophy [J]. Can J Urol, 2018, 25(2): 9228-9237.

暂无相关信息！

九十余年来，使用单极电切镜进行的经尿道前 列腺电切术 （monopolar transurethral resection of the prostate，M-TURP） 被认为是治疗由良性前列 腺增生导致的下尿路症状的“金标准”，临床效果确 切且符合成本效益原则[1-4] 。随着技术的进步，双极 电切镜的出现或许为TURP手术提供了一种更好的设 备选择，即双极TURP（Bipolar TURP，B-TURP）。 相比于 M-TURP，B-TURP 使用生理盐水作为冲 洗液，疗效相近的同时明显降低了术中并发症的发生 率[2-4] 。然而，无论使用何种能量平台，前尿道狭窄 仍是 TURP 术后主要的晚期并发症之一[5-6] 。本文旨 在收集和总结 TURP 术后前尿道狭窄的流行病学、病因学和处理策略等。

1 流行病学

2 病因学

    2.1 机械损伤

    2.2 电损伤

    2.3 感染

    2.4 留置尿管

    2.5 其他

3 处理策略

    3.1 尿道扩张术和尿道内切开术

    3.2 尿道重建术

        3.2.1 短段的球部尿道狭窄

        3.2.2 长段的球部尿道狭窄

        3.2.3 阴茎部尿道狭窄

    3.3 尿道会阴造口术

4 TURP 术后尿道狭窄的预防

4 TURP 术后尿道狭窄的预防

TURP 术后前尿道狭窄对接受 TURP 手术的患 者来说是一个无法忽视的问题，但患者往往没有充 分意识到潜在的终身后果。20世纪的医疗器械技术 依赖于利用大功率的电流或激光能量进行前列腺组 织切除或消融，通常需要一个大尺寸镜鞘，这是尿 道损伤和术后狭窄形成的主要原因。进入 21 世纪， 微创的创新性设备和技术更广泛的应用于临床，希 望尺寸更小金属镜鞘和更短的手术时间将降低功能 并发症和尿道狭窄的发生率[41] 。

TURP 相关前尿道损伤是医源性尿道狭窄的主 要原因，临床上对此类患者的诊治具有挑战性。临 床医生应该了解这类问题的确切病因，思考在TURP 术中如何保护尿道黏膜的完整性。关于 TURP 术后 前尿道狭窄的治疗方式并无统一意见，内镜下微创 治疗的效果无法保证，尤其是对于长段或严重狭窄的患者，狭窄复发率很高。实际上，口腔黏膜移植 物，包括颊黏膜和舌黏膜，是最常用的前尿道成形 术补片材料。对于患有多种基础病和严重或全尿道 狭窄疾病的老年患者，尿道会阴造口术不仅是临床 上重要的治疗手段，而且往往是为这些患者恢复正 常排尿功能的明智选择。

暂无相关信息！

暂无相关信息！