美国泌尿外科协会尿道狭窄疾病指南修正案解读  

Interpretation on the American Urological Association's Urethral Stricture Disease Guideline Amendment

作　　者：张睿航 宋鲁杰 傅强[1,2] ZHANG Ruihang;SONG Lujie;FU Qiang(Department of Urology,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai,200233,China;Shanghai Eastern Institute of Urological Reconstruction)

机构地区：[1]上海交通大学医学院附属第六人民医院泌尿外科,上海200233 [2]上海东方泌尿修复重建研究所

出　　处：《临床泌尿外科杂志》2025年第3期226-229,237,共5页Journal of Clinical Urology

摘　　要：2023年7月,美国泌尿外科协会(American Urological Association,AUA)发布了2023年尿道狭窄指南修正案。通过使用Pubmed、Embase和Cochrane数据库进行文献的系统回顾,识别与男性尿道狭窄的诊断和治疗相关的同行评议文章。2023年修正案的文献检索相比2016年的指南进行了修改,新增了女性和男性尿道狭窄的文献(男性搜索日期为2015年12月—2022年10月;女性搜索日期为1990年—2022年10月),并添加了有关性功能障碍的关键问题(搜索日期:1990年—2022年10月)。在经过纳排标准筛选后,增添了81项研究。结果表明,诊断尿道狭窄后,应准确确定狭窄的长度和位置,以指导治疗。在尿道休息期后,患有短(<2 cm)球部尿道狭窄的患者可以进行内镜治疗;经验丰富的医生可对首次或复发的前或后尿道狭窄患者进行尿道成形术治疗。女性患者尿道狭窄的最佳治疗选择是使用口腔黏膜或阴道瓣进行尿道成形术,而非内镜治疗。此外,值得注意的是,2023年修正案将硬化性苔藓(lichen sclerosus,LS)列为一个单独板块,体现出LS尿道狭窄正受到越来越多的关注。In July 2023,the American Urological Association(AUA) released the 2023 revisions to the guidelines for urethral stricture.A systematic review of the literature was conducted using PubMed,Embase,and Cochrane databases to identify peer-reviewed articles related to the diagnosis and treatment of male urethral stricture.Compared to the 2016 guidelines,the 2023 revisions included updated literature on both male and female urethral stricture(with the male search covering the period from December 2015 to October 2022,and the female search covering 1990 to October 2022).Additionally,key issues regarding sexual dysfunction were incorporated(search date:1990 to October 2022).After applying inclusion and exclusion criteria,81 studies were added to the review.The findings indicate that after diagnosing urethral stricture,it is essential to accurately determine the length and location of the stricture to guide treatment.For patients with short(<2 cm) bulbar urethral stricture,endoscopic treatment is recommended after a period of urethral rest.Urethroplasty is suggested for first-time or recurrent anterior or posterior urethral strictures in patients treated by experienced surgeons.For female patients,the optimal treatment for urethral stricture is urethroplasty using either oral mucosa or vaginal flaps,rather than endoscopic procedures.Notably,the 2023 revision highlights lichen sclerosus(LS) as a separate category,reflecting growing attention to LS-induced urethral stricture.

关 键 词：尿道狭窄 硬化性苔藓 指南 美国泌尿外科协会 

分 类 号：R695[医药卫生—泌尿科学]