Üretra Darlığında Endoskopik Cerrahi: Bıçağa Karşı Lazer

Amaç: Üretra darlığının endoskopik cerrahisinde cold knife üretrotomi ile laser üretrotominin etkinliğini karşılaştırmayı amaçladık. Materyal-metod: Toplam 171 hasta retrospektif olarak değerlerlendirildi. Çalışma kapsamında verileri tam olan 118 hasta 2 gruba ayrıldı (grup 1; n=53 cold knife üretrotomi, grup 2; n= 65 lazer üretrotomi). Darlığın uzunluğu, operasyon süresi, preoperatif ve postoperatif 3., 6. ve12. aylardaki Qmax değerleri, nüks olup olmadığı ve komplikasyon varlığı (kanama, extravazasyon, ateş gb) açısından iki grup karşılaştırıldı. Bulgular: Operasyon zamanının cold knife üretrotomi yapılan hastalarda daha kısa olduğu görüldü (14.01 ± 3.86 dk vs 25.03 ± 4.43 dk, p=0.001). Postoperatif 3., 6., ve 12. aylardaki Q max değerlerinin lazer üretrotomi yapılan hastalarda daha yüksek olduğu görüldü (p=0.03, p=0.001, p=0.001). Bir yıllık takip sonucunda grup-1' de 28 (52.83%) hastada nüks saptanırken, grup-2' de 12 (18.46%) hastada nüks geliştiği gözlendi (p=0.01). Postoperatif komplikasyonlar açısından her iki grup arasında istatiksel olarak anlamlı fark izlenmedi. (p=0.209). Sonuç: Yaptığımız bu çalışmada üretra darlığını endoskopik cerrahisinde, lazer üretrotomi tekniğinin, cold knife üretrotomiye göre yüksek Qmax değerlerine ve daha düşük nüks oranına sahip olması nedeniyle daha başarılı bir cerrahi yöntem olduğu saptanmıştır. Sonuçların prospektif, randomize çalışmalarla desteklenmesi gerekmektedir.

Anahtar Kelimeler:

üretral darlık, lazer üretrotomi, soğuk bıçak, nüks

Endoscopic Surgery of Urethral Strictures: Laser Versus Knife

Aims: We aimed to compare the efficiency of cold knife urethrotomy and laser urethrotomy in endoscopic surgery of urethral strictures. Material-Methods: A total of 171 patients were evaluated retrospectively. A 118 patients with complete data were divided into two groups (group 1; n = 53 cold knife urethrotomy, group 2; n = 65 laser urethrotomy) in the study. Length of the stricture, operation time, preoperative and postoperative 3rd, 6th and 12th-month Qmax values, recurrence and the presence of complications (such as bleeding, extravasation, fever etc.) were compared in terms of the two groups. Results: The operation time was found to be shorter in patients who underwent cold knife urethrotomy (14.01 ± 3.86 min vs 25.03 ± 4.43 min, p=0.001). The Q max values at the postoperative 3rd, 6th and 12th months were observed to be higher in patients who underwent laser urethrotomy (p=0.03, p=0.001, p=0.001). At the end of a one-year follow-up, recurrence was determined in 28 (52.83%) patients in group 1 and 12 (18.46%) patients had a recurrence in group 2 (p=0.01). No statistically significant difference was observed between the two groups in terms of postoperative complications. (p=0.209).Conclusions: In this study, it was determined that laser urethrotomy technique was a more successful surgical method than cold knife urethrotomy in the endoscopic surgery of urethral strictures as it has higher Qmax values and lower recurrence rate. The results should be supported by prospective, randomized studies.

Keywords:

urethral stricture, laser urethrotomy, cold knife, nux,

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