SIU/ICUD Consultation on Urethral Strictures: Posterior Urethral Stenosis After Treatment of Prostate Cancer
SIU/ICUD Consultation on Urethral Strictures: Posterior Urethral Stenosis After Treatment of Prostate Cancer
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DOI：
10.1016/j.urology.2013.08.036
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发表时间：
2014-03-01
期刊：
影响因子：
2.1
通讯作者：
Zinman, Leonard
中科院分区：
文献类型：
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作者：
Herschorn, Sender;Elliott, Sean;Zinman, Leonard
根治性尿道切除术可导致约5%-10%的患者发生后尿道狭窄（范围1.4%-29%）。同样，近距离放射治疗后4%-9%的男性和外照射放射治疗后1%-13%的男性会发生狭窄。联合治疗后的发生率会更高，在补救性根治性切除术后可超过40%。尽管放射性膀胱切除术后狭窄大多在2年内发生，但放射治疗后狭窄需要更长时间才出现。许多导致储存和排尿症状，并可能与失禁有关。评估包括类似于下尿路症状的检查，以及排除复发或持续性前列腺癌的额外测试。治疗通常采用内窥镜方法开始，通常包括扩张，目视尿道切开术（有或无激光治疗），以及可能的UroLume支架放置。开放性尿道成形术和尿流改道术治疗尿道狭窄已有报道。已经提供了示出分级方法的所提出的算法。(C)2014爱思唯尔公司
Posterior urethral stenosis can result from radical prostatectomy in approximately 5%-10% of patients (range 1.4%-29%). Similarly, 4%-9% of men after brachytherapy and 1%-13% after external beam radiotherapy will develop stenosis. The rate will be greater after combination therapy and can exceed 40% after salvage radical prostatectomy. Although postradical prostatectomy stenoses mostly develop within 2 years, postradiotherapy stenoses take longer to appear. Many result in storage and voiding symptoms and can be associated with incontinence. The evaluation consists of a workup similar to that for lower urinary tract symptoms, with additional testing to rule out recurrent or persistent prostate cancer. Treatment is usually initiated with an endoscopic approach commonly involving dilation, visual urethrotomy with or without laser treatment, and, possibly, UroLume stent placement. Open surgical urethroplasty has been reported, as well as urinary diversion for recalcitrant stenosis. A proposed algorithm illustrating a graded approach has been provided. (C) 2014 Elsevier Inc.