Journal of Reconstructive Urology

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Üretral Darlıklarda Unutulan Bir Tedavi; Cerrahi Sonrası Düzenli Dilatasyon
A Forgotten Treatment in Urethral Stricture; Regular Dilatation After Surgery
Serkan DOĞANa, Cavit CEYLANa
aÜroloji Kliniği, Sağlık Bilimleri Üniversitesi Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Ankara, TÜRKİYE
J Reconstr Urol. 2019;9(1):11-5
doi: 10.5336/urology. 2019-64849
Article Language: TR
Full Text
ÖZET
 Amaç: İnternal üretrotomi, üroloji kliniklerinde en sık yapılan cerrahi uygulamalarından biridir. Çalışmanın amacı, çeşitli sebeplerle anterior üretra darlığı gelişen hastalarda erken üretral kateter dilatasyonunun (yumuşak self kateter) nüks üzerine etkisinin araştırılmasıdır. Gereç ve Yöntemler: Kliniğimizde soğuk bıçak yöntemiyle internal üretrotomi yapılan 42 hasta, dilatasyon uygulanan zamana göre gruplandırıldı; üçüncü ay sonunda üroflowmetri sonucuyla değerlendirilip gruplar arasındaki fark karşılaştırıldı. Dilatasyonun ilk uygulama zamanı postoperatif beşinci gün olan ve altı kez/aylık toplam 18 kez dilatasyon yapılan 1. grup 16 hasta, uygulama zamanı postoperatif 15. gün olan iki kez/aylık toplam altı kez dilatasyon yapılan 2. grup 13 hasta ve dilatasyon uygulanmayan 3. grup 13 hasta olmak üzere toplam 42 hasta çalışmaya dâhil edildi. Üçüncü ay sonunda üroflowmetri ile değerlendirilen hastalar erken nüks oranları açısından karşılaştırıldı. Bulgular: Erken dilatasyon uygulanan, anterior üretra darlıklı 1. gruptaki hastalarla geç başlangıçlı dilatasyon uygulanan 2. gruptaki hastalar arasında nüks açısından istatistiksel olarak anlamlı fark saptanmadı. Dilatasyon uygulanmayan 3. grupta, 1. gruba göre nüks lehine istatistiksel olarak anlamlı bir fark saptandı. Dilatasyon uygulanan 1 ve 2. gruplar dilatasyon uygulanmayan 3. grupla karşılaştırıldığında sınırda anlamlı fark saptanırken, 2. grup ile 3. grubun kıyaslamasında istatistiksel olarak anlamlı fark bulunmadı. Sonuç: İnternal üretrotomi sonrası sık tekrarlayan nüks en büyük sorundur. Bu nedenle uygulanan mükerrer internal üretrotomiler hem başarı açısından düşük yüzdelere sahiptir hem de bu yaklaşım, daha sonra uygulanacak üretroplastinin başarı şansını azaltmaktadır. Postoperatif erken dilatasyon ile bu endoskopik yöntemin başarı oranının artırılabileceği ve mükerrer üretral darlıkların önüne geçilebileceği düşünülmektedir.

Anahtar Kelimeler: İnternal üretrotomi; erken dilatasyon; nüks
ABSTRACT
 Objective: Internal urethrotomy is one of the most frequently performed surgeries in urology clinics. The aim of this study was to investigate the effect of early urethral catheter dilatation (soft self-catheter) on recurrence in patients with anterior urethral stricture. Material and Methods: The patients who underwent internal urethrotomy with cold knife method were grouped according to the time of dilatation and evaluated by uroflowmetry at the end of the third month. A total of 42 patients were included in the study. The patients who underwent first dilatation at the 5th day after the operation, with a total number of 18 dilatations (16 patients), were included in the first group. The patients who underwent first dilatation at the 15th day after the operation, with a total number of 6 dilatations (13 patients), were included in the second group. The patients who did not undergo dilatation were included in the third group (13 patients). Patients were compared in terms of early recurrence rates with uroflowmetry at the end of the third month. Results: There was no statistically significant difference between the first and second group of patients in terms of recurrence in ureteral stricture. However, there was a statistically significant difference in terms of relapse in urethral stricture between the first group and the third group who had not gone dilatation. There was no statistically significant difference between the second and third groups. When compared in terms of the same variable. Conclusion: Recurrent strictures after internal urethrotomy is the most challenging problem. Repeated internal urethrotomy have low success rates and also decrease the success rate of urethroplasty. We suggest that the success rate of the endoscopic method can be increased by postoperative early dilatation and by this approach, repeated urethral strictures can be prevented.

Keywords: Internal urethrotomy; early dilatation; recurrence
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