Transurethral Holmium Laser Combined With Electro-incision To Treat Complex Urethral Stricture

Objective To evaluate the clinical effect of combined holmium laser incision with electro-incision to treat complex urethral stricture and atresia.Methods A total of 70 patients who were diagnosed with urethral stricture and atresia from Jan 2004 to Sep 2008 in Shandong provincial hospital were divided into three groups,30 cases were taken open surgery;20 cases were taken combined cryo-scalpel incision with electro-incision;20 cases were taken combined holmium laser incision with electro-incision.The significant markers and therapeutic results were recorded and analyzed,which includes operating time,the blood loss,length of stay in hospital,the time of Foley catheters indwelled,the number of time for urethra dilation,the cure rate and Qmax..The therapeutic effects were compared in the three groups.Results 1,open surgery have obvious advantage than transurethral transluminal surgery in the treatment of complex anterior urethral sticture,especially in the treatment of long segment and multi-segment urethral stricture of penis,anterior urethral stricture with urethrocele or urinary fistula.2,The operation time of each group(the group of open surgery,the group of combined cryo-scalpel incision with electro-incision,the group of combined holmium laser incision with electro-incision) which was used to treat complex posterior urethral stricture and atresia were 132.5±6.7min,82.4±3.5min and 51.6±4.8min separately;the blood loss were 258.5±23.8ml,20ml and 5ml separately.The difference among the three groups were significant(P＜0.05),the group of combined holmium laser incision with electro-incision were better than the other two groups.3,The length of stay in hospital for each group(the group of open surgery, the group of combined cryo-scalpel incision with electro-incision,the group of combined holmium laser incision with electro-incision) which was used to treat complex posterior urethral stricture and atresia were 25.2±4.7d,20.5±3.2d and 19.3±4.6d separately;the time of Foley catheters indwelled were 30.5±6.1d,21.5±4.7d and 20.8±3.2d separately.The difference between the group of combined holmium laser incision with electro-incision and the group of combined cryo-scalpel incision with electro-incision were not significant(P＞0.05),the difference between the group of open surgery and the other two groups were significant(P＜0.05).4,60 cases were followed up for 6 to 24 months,average follow-up perd were 12 months.The number of time for urethra dilation of each group(the group of open surgery,the group of combined cryo-scalpel incision with electro-incision,the group of combined holmium laser incision with electro-incision)were14.7±2.8,15.1±3.3 and 13.2±1.9;the Qmax were 19.5±3.2 ml/s,17.8±3.4ml/s and 18.4±2.7ml/s. No significant differences were found among the three groups(p＞0.05).There were 1 cases of incontinence of urine and 2 cases of ED in the group of open surgery;1 cases of incontinence of urine and 0 cases of ED in the group of combined cryo-scalpel incision with electro-incision;0 case of incontinence of urine and 0 cases of ED in the group of combined holmium laser incision with electro-incision.5,In the treatment of complex posterior urethral stricture and atresia,14 cases were cured in the 17 cases of open surgery,the cure rate is 82.4%;12 cases were cured in the 14 cases of combined cryo-scalpel incision with electro-incision,the cure rate is 85.7%;13 cases were cured in the 15cases of combined holmium laser incision with electro-incision,the cure rate is 86.7%.There were no differences among the three groups in the cure rate.Conclusions 1,open surgery have obvious advantage than transurethral transluminal surgery in the treatment of complex anterior urethral sticture,especially in the treatment of long segment and multi-segment urethral stricture of penis,anterior urethral stricture with urethrocele or urinary fistula.2,The treatment of complex posterior urethral sticture and atresia with transurethral holmium laser combined with electro-incision has the advantages of safety,effectiveness,minimal invasion,less complications,low recurrence rate and faster postoperative recovery,is a better method for the treatment of complex posterior urethral sticture and atresia.