Endoscopic laser-urethroplasty

摘要

Introduction : The objective was to prove the advantage of endoscopic laser-urethroplasty over internal urethrotomy in acquired urethral strictures. Patients and Method: From January, 1996 to June, 2005, 35 patients with a mean age of 66 years were submitted to endoscopic laser-urethroplasty for strictures of either the bulbar (30) or membranous (5) urethra. The operations were carried out under general anesthesia. First of all, the strictures were incised at the 4, 8 and 12 o'clock position by means of a Sachse-urethrotom. Then the scar flap between the 4 and 8 o'clock position was vaporized using a Nd:YAG laser, wavelength 1060 nm and a 600 μm bare fiber, the latter always being in contact with the tissue. The laser worked at 40W power in continuous mode. The total energy averaged 2574 J. An indwelling catheter was kept in place overnight and the patients were discharged the following day. Urinalysis, uroflowmetry and clinical examination were performed at two months after surgery and from then on every six months. Results: No serious complications were encountered. Considering a mean follow-up of 18 months, the average peak flow improved from 7.3 ml/s preoperatively to 18.7 ml/s postoperatively. The treatment failed in 5 patients (14.3%) who finally underwent open urethroplasty. Conclusions: Endoscopic laser-urethroplasty yields better short-term results than internal visual urethrotomy. Long-term follow-up has yet to confirm its superiority in the treatment of acquired urethral strictures.