Adult anterior urethral strictures: A national practice patterns survey of board certified urologists in the United States
Adult anterior urethral strictures: A national practice patterns survey of board certified urologists in the United States
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DOI：
10.1016/j.juro.2006.09.052
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发表时间：
2007-02-01
影响因子：
6.6
通讯作者：
Brandes, Steven B.
中科院分区：
文献类型：
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作者：
Bullock, Travis L.;Brandes, Steven B.
目的：我们确定美国执业泌尿科医师对成人前尿道狭窄疾病的评估和治疗方法和模式。材料与方法：采用邮寄问卷的方式对美国泌尿外科协会执业会员进行全国性调查。从全美50个州随机抽取了1262名泌尿科医生，其中431名（34%）完成了问卷调查。结果：大多数泌尿科医师（63%）每年治疗6 ~ 20例尿道狭窄。尿道扩张术（92.8%）、光学尿道内切开术（85.6%）和尿道内支架（23.4%）是尿道狭窄最常见的治疗方法。微创手术比任何开放性尿道成形术更常用。此外，大多数泌尿科医生（57.8%）不做尿道成形术。当使用时，最常见的输尿管成形术是端到端吻合输尿管成形术、会阴输尿管成形术和腹侧皮肤移植输尿管成形术。很少有泌尿科医生（4.2%）进行口腔黏膜移植。对于难以行尿道内切开术的长球尿道狭窄或短球尿道狭窄，20%至29%的受访者会转诊其他泌尿科医生，而31%至33%的受访者会继续采用微创方法治疗狭窄，尽管可预见的失败。74%的泌尿科医生认为文献支持重建手术阶梯，其中只有在内镜方法多次失败后才进行尿道成形术。结论：美国大多数泌尿科医生对尿道成形术缺乏经验。大多数泌尿科医生错误地认为，文献支持重建手术梯尿道狭窄的管理。对文献的不熟悉和对尿道成形术的缺乏经验使得内窥镜方法的使用不恰当地普遍。
Purpose: We determined the methods and patterns of the evaluation of and treatment for adult anterior urethral stricture disease by practicing urologists in the United States.Materials and Methods: A nationwide survey of practicing members of the American Urological Association was performed by a mailed questionnaire. A total of 1,262 urologists were randomly selected from all 50 states, of whom 431 (34%) completed the questionnaire.Results: Most urologists (63%) treat 6 to 20 urethral strictures yearly. The most common procedures used by those surveyed for urethral strictures were dilation (92.8%), optical internal urethrotomy (85.6%) and endourethral stent (23.4%). Minimally invasive procedures are used more frequently that any open urethroplasty technique. Furthermore, most urologists (57.8%) do not perform urethroplasty surgery. When used, the most common urethroplasty surgeries performed were end-to-end anastomotic urethroplasty, perineal urethrostomy and ventral skin graft urethroplasty. Few urologists (4.2%) performed buccal mucosa grafts. For a long bulbar urethral stricture or short bulbar urethral stricture refractory to internal urethrotomy 20% to 29% of respondents would refer to another urologist, while 31% to 33% would continue to manage the stricture by minimally invasive means despite predictable failure. Of the urologists 74% believed that the literature supports a reconstructive surgical ladder, in which urethroplasty is only performed after repeat failure of endoscopic methods.Conclusions: Most urologists in the United States have little experience with urethroplasty surgery. Most urologists erroneously believe that the literature supports a reconstructive surgical ladder for urethral stricture management. Unfamiliarity with the literature and inexperience with urethroplasty surgery have made the use of endoscopic methods inappropriately common.