ÜRETRAL DARLIKLARIN OPTÝK ÜRETROTOMÝ ÝNTERN ÝLE TEDAVÝSÝ

Travmaya baðlý inkomplet üretra rüptürleri geç dönemde üretral darlýk geliþmesine neden olabilir. Bu darlýklarýn optik üretrotomla tedavisi yaygýn olarak kullanýlan bir tedavi modelidir. Ekim 1994 Mart 1998 tarihleri arasýnda inkomplet üretra rüptürü nedeniyle sistostomize edilip, optik üretrotomla tedavi edilen 22 hasta, retrospektif olarak, preoperatif ve postoperatif retrograd / voiding sistoüretrografý, üroflowmetri parametreleri açýsýndan deðerlendirildi. Preoperatif üretrografilerde ortalama darlýk uzunluðu 11.82 + 6.12 mm, üroflowmetride ortalama Qmax deðerleri 7.36+ 2.63 ml/sn idi. Hastalarýn tümü optik üretrotomla tedavi edildi. Postoperatif Qmax deðerleri 19.36+6 ml/sn olarak saptandý. Ortalama takip süresi 21.18 + 9.56ay idi ve 16 hasta tek seansta tedavi edildi. 3 hastada rekürran darlýk geliþti ve bu hastalara ikinci seans optik üretrotomi uygulandý. 3 hastaya da benign prostat hiperplazisi için transüretral rezeksiyon yapýldý. Travmaya baðlý oluþan inkomplet üretra rüptürlerinde, iyatrojenik komplet üretra rüptürüne neden olmamak için hastalar baþlangýçta sistostomize edilip, geç dönemde reparasyon uygulanmalýdýr. Bu, yalnýzca tedavinin etkinliðini artýrmakla kalmaz, ayný zamanda komplikasyon oranýný da azaltýr.

TREATMENT OF URETHRAL STRICTURES BY OPTIC URETHROTOME

Incomplete urethral ruptures due to trauma may lead to urethral stricture development in the late period. Treatment of these strictures by optic urethrotome is a commonly used treatment modality. Between October 1994 and March 1998, 22 patients that were cystostomized due to incomplete urethral rupture and treated by optic urethrotome evaluated retrospectively by preoperative and postoperative retrograde/voiding cystourethrographies and by uroflowmetry. Preoperative urethrographies showed stenosis with a mean length of 11.82 + 6.12 mm and mean Q max in uroflowmetry was 7.36+2.63 ml/sec. All of the patients were treated by optic urethrotome. Postoperative Q max was 19.36 +6 ml/sec.The average follow-up period was 21.18 +9.56 months and 16 patients treated in the first attempt. Recurrent stricture developed in 3 patients and those underwent a repeat optic urethrotome. Transurethral resection applied to 3 patients for benign prostatic hyperplasia. Patients who had incomplete urethral ruptures because of trauma should initially be cystostomized and repair should be applied in late period in order to avoid an iatrogenic complete rupture. This will not only increase the treatment chance, but also decrease the rate of complications.