Barbaros BAŞESKİOĞLU, Aydın YENİLMEZ, İyimser ÜRE, Burak ELMAAĞAÇ

KOMPLET ÜRETRAL DARLIKLARININ ENDOSKOPİK TEDAVİSİ 'CUT TO THE LIGHT'

Amaç: Günümüzde komplet üretral darlıklarının tedavisinde birden fazla tedavi seçeneği mevcuttur. Açık cerrahi yöntemlerinin yanı sıra düşük morbidite, uygulanabilme kolaylığı nedeniyle endoskopik tedaviler de uygulanmaktadır. Bu çalışmada komplet üretral darlık nedeniyle yapılan endoskopik tedavi 'cut to the light' yönteminin sonuçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Hastane kayıtları incelenerek, iatrojenik ve pelvik travma öyküsü olan tüm komplet üretral darlık nedeniyle tedavi olan hastaların dataları retrospektif olarak kayıt altına alındı.Bu grup hastalardan 'cut to the light' dışında tedavi uygulananlar çalışmadan çıkarıldı. Tüm hastalarda işlem öncesi sistostomi kateteri mevcuttu. Sistostomi kateterinden mesane serum fizyolojik ile doldurularak perkütan giriş yapıldı, dilatasyonu takiben mesaneye fleksibl sistoskop ile girilirken eş zamanlı olarak üretradan üretrotomla girildi. Fleksibl sistoskopun komplet darlığın arkasında görülen ışığı rehber olacak şekilde üretrotomun soğuk bıçağı ile komplet darlık kesildi. Takip süresince rekürren darlıklar kayıt altına alındı. Bulgular: Toplam on hastaya 'cut to the light' işlemi uygulandı. Ortalama yaş 51 idi. Etiyolojide hastaların %50'si iatrojenik, %50'si travmatik nedenliydi. Hastaların altısında charlson komorbidite skoru 3 ve üzeriydi. Ortalama takip süresi 405 gündü. Nüks oranı %50 idi. Tüm nüksler internal üretrotomi ile tedavi edildi.Hastaların dördü takipte komorbiditeye bağlı exitus oldu. Sonuç: Uygulama kolaylığı, düşük morbidite oranları ve hastanın hastanede kalış süresinin oldukça kısa olması nedeniyle komplet üretral darlıklarının endoskopik tedavisi üretroplasti öncesi bir basamak olabilir.

Endoscopic Treatment of Complete Urethral Strictures 'Cut to the light'

Objectives: Today, in the treatment of complete urethral strictures multiple treatment options are available. As well as open surgery, endoscopic treatments are applied, because of the ease of implementation and lower morbidity. In this study, we aimed to evaluate the results of endoscopic therapy 'cut to the light' method due to complete urethral strictures Material and Methods: All data of patients treated with complete urethral strictures due to pelvic trauma or iatrogenic were recorded retrospectively by examining hospital records. From this group of patients, those treated with the exception of 'cut to the light' were excluded from the study. All patients had cystotomy catheter before the procedure. Percutaneous access was done after filling the bladder with saline from the cystostomy catheter. Flexible cystoscopy was done after dilatation while urethrotome was inserted through the urethra simultaneously. Under the guidance of flexible cystoscopy light behind the complete stricture, it was cut by urethrotome with cold knife. Recurrent stenoses were recorded during follow-up.Results: A total of ten patients 'cut to the light' procedure was performed. The mean age was 51 . Etiology was iatrogenic in 50% of patients while traumatic in 50%. Six patients had Charlson comorbidity score of 3 or higher. Mean follow-up time was 405 days. The recurrence rate was 50%. All recurrences were treated with internal urethrotomy. Four patients at follow-up were exitus depending on comorbiditiesConclusion: Because of the ease of implementation, lower morbidity, and relatively short duration in hospital Endoscopic treatment of complete urethral stricture may be a step ahead than urethroplasty.

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