Abstract: Objectives: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation (HPBD) technique for anterior urethral stricture. Methods: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient demographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min, P<0.01). For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection (UTI) were less frequently encountered than those in DVIU (urethral bleeding: 2/31 vs. 8/25, P=0.017; UTI: 1/31 vs. 6/25 P=0.037). The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups (P=0.21, hazard ratio (HR)=0.65, 95% confidence interval (CI): 0.34 to 1.26). However, there was a significantly higher stricture-free survival in the HPBD group at 12 months (P=0.02, HR=0.35, 95% CI: 0.14 to 0.87), which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions: HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.

高压球囊扩张治疗男性前尿道狭窄：单中心的临床经验

[1]Anger, J.T., Buckley, J.C., Santucci, R.A., et al., 2011a. Trends in stricture management among male medicare beneficiaries: underuse of urethroplasty? Urology, 77(2):481-485.

[2]Anger, J.T., Scott, V.C., Sevilla, C., et al., 2011b. Patterns of management of urethral stricture disease in the veterans affairs system. Urology, 78(2):454-458.

[3]Bullock, T.L., Brandes, S.B., 2007. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J. Urol., 177(2):685-690.

[4]Gupta, N.P., Mishra, S., Dogra, P.N., et al., 2009. Outcome of end-to-end urethroplasty: single-center experience. Urol. Int., 82(2):179-182.

[5]Hameed, A., Mohammed, A., Nasir, S., et al., 2011. Management of bulbar urethral strictures: review of current practice. Can. J. Urol., 18(3):5676-5682.

[6]Heyns, C.F., Steenkamp, J.W., de Kock, M.L., et al., 1998. Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful? J. Urol., 160(2):356-358.

[7]Hudak, S.J., Atkinson, T.H., Morey, A.F., 2012. Repeat transurethral manipulation of bulbar urethral strictures is associated with increased stricture complexity and prolonged disease duration. J. Urol., 187(5):1691-1695.

[8]Isen, K., Nalcacioglu, V., 2015. Direct vision internal urethrotomy by using endoscopic scissors. Int. Urol. Nephrol., 47(6):905-908.

[9]Ishigooka, M., Tomaru, M., Hashimoto, T., et al., 1995. Recurrence of urethral stricture after single internal urethrotomy. Int. Urol. Nephrol., 27(1):101-106.

[10]Kuntz, N.J., Neisius, A., Tsivian, M., et al., 2015. Balloon dilation of the ureter: a contemporary review of outcomes and complications. J. Urol., 194(2):413-417.

[11]Lewis-Russell, J.M., Natale, S., Hammonds, J.C., et al., 2004. Ten years’ experience of retrograde balloon dilatation of pelviureteric junction obstruction. BJU Int., 93(3):360-363.

[12]Mundy, A.R., Andrich, D.E., 2011. Urethral strictures. BJU Int. 107(1):6-26.

[13]Parente, A., Angulo, J.M., Romero, R.M., et al., 2013. Management of ureteropelvic junction obstruction with high-pressure balloon dilatation: long-term outcome in 50 children under 18 months of age. Urology, 82(5):1138-1143.

[14]Santucci, R., Eisenberg, L., 2010. Urethrotomy has a much lower success rate than previously reported. J. Urol., 183(5):1859-1862.

[15]Santucci, R.A., Joyce, G.F., Wise, M., 2007. Male urethral stricture disease. J. Urol., 177(5):1667-1674.

[16]Singh, O., Gupta, S.S., Arvind, N.K., 2011. Anterior urethral strictures: a brief review of the current surgical treatment. Urol. Int., 86(1):1-10.

[17]Tinaut-Ranera, J., Arrabal-Polo, M.A., Merino-Salas, S., et al., 2014. Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty. Can. Urol. Assoc. J., 8(1-2):E16-E19.

[18]Tonkin, J.B., Jordan, G.H., 2009. Management of distal anterior urethral strictures. Nat. Rev. Urol., 6(10):533-538.

[19]van Leeuwen, M.A., Brandenburg, J.J., Kok, E.T., et al., 2011. Management of adult anterior urethral stricture disease: nationwide survey among urologists in the Netherlands. Eur. Urol., 60(1):159-166.

[20]Veeratterapillay, R., Pickard, R.S., 2012. Long-term effect of urethral dilatation and internal urethrotomy for urethral strictures. Curr. Opin. Urol., 22(6):467-473.

[21]Wright, J.L., Wessells, H., Nathens, A.B., et al., 2006. What is the most cost-effective treatment for 1 to 2-cm bulbar urethral strictures: societal approach using decision analysis. Urology, 67(5):889-893.

[22]Yu, H.L., Ye, L.Y., Lin, M.H., et al., 2011. Treatment of benign ureteral stricture by double J stents using high-pressure balloon angioplasty. Chin. Med. J. (Engl.), 124(6):943-946.