| Objective We sought to evaluate the effectiveness、safety and feasibility of using bipolar plasma vaporization:plasma-cut electrode combined with plasma-loop electrode instruments in the treatment of posterior urethral stricture through comparing with the conventional cold-knife urethrotomy.Methods In our study,the research is a single-center、single blind randomized trial with parallel designs.112 male patients with posterior urethral strictures were randomized into two groups From june 2013 to august 2015:the bipolar group (n=56) and the cold-knife group (n=56). Among them, the membranous urethral stricture was the most frequent location of urethral strictures:101 cases (81.9%), followed by prostatic urethra 11cases(18.1%). A randomised trial was performed to compare the bipolar group with the cold-knife group. In our study,the data were collected as follows:Qmax、preoperative age、QOL、PVR and the length of stricture, the date of urethrography、uroflowmetry and the location of stricture were also collected. Duration of operation and the complication such as intraoperative blood loss、urine tract infection、by-pass were collected. All patients were assessed at 1 months、 3months、6 months、9months and 12 months post operation by uroflowmetry、 urethrography and Qol,At the end of the first year post operation, we performed urethroscopy to evaluate the efficacy and safety of the procedure. The mean follow up time was 13.9 months (rang from 12 to 21 months). If re-stenosis was not identified by both urethrography and urethroscopy, the results were considered as "successful".Results During follow-ups, the outcomes were accepted as successful if the maximum flow was greater than 15ml/sec without any obstructive symptoms and no or insignificant recurrent stricture was found by urethrography or urethroscopy. General conditions of two groups:age (41.85±6.87vs 42.65±8.64year),PVR (59.86±2.48ml vs 61.25±2.89ml),length of strictures(13.23±2.48mm vs 12.45±2.89mm),QOL(4.5±0.70; 4.68±0.80),Qmax (4.68±1.88 vs78±1.47 ml/s):these data are comparative without statistical significance.Compared with cold-knife group, bipolar group had shorter operative time in our study((23.45±7.64 vs 33.45±5.45min),there were significant statistical difference(t=2.25, P<0.05). Patients in both groups were free of severe hyponatremia,urinary incontinence,bladder injury,rectal injury. In bipolar group, the Qmax of 1 months±3 months± 6 months±9months and 12 months post operation were (19.54±1.78ml/s; 18.54±1.74 ml/s; 18.32±2.78 ml/s; 18.34±1.74 ml/s; 17.25±2.12ml/s),In cold group,these were (17.54±2.36ml/s; 17.51±2.26ml/s; 16.55±1.15ml/s; 14.58±1.36ml/s; 13.54±2.78 ml/s). In bipolar group, the QOL of 1 months、3months、6 months、9months and 12 months post operation were(2.3±0.8; 2.5±0.6; 2.5±0.9; 2.9±0.7; 3.5±0.8), In cold group,these were(2.6±0.7; 2.5±0.8; 2.7±0.8; 3.3±0.7; 4.5±0.8). At a mean follow-up time of 13.9 months the success rate was 87.5%(49/56) In bipolar group,Recurrent stricture was found in 7 cases,the recurrenc rate was 12.5%(7/56). The success rate in cold-knife group was 53.6%(30/56),the recurrenc rate was 46.4%, Compared with that in the cold-knife group success rate was significantly higher in the bipolar plasma group, there were significant statistical difference between two groups (P<0.01).Conclusions Compared with Cold-knife group,bipolar group has a high successrate,After the vaporization of plasma-cut electrode, the urethra was generally not smooth, Plasma-loop electrode instruments were combined sequentially, After the vaporization of plasma-loop electrode, the urethral passage became more smooth, in the management of urethral stricture disease, plasma-cut electrode combined with plasma-loop electrode instruments is a safe and reliable method, which minimizes surgical morbidity for urethral stricture resection and demonstrates advantages in lower recurrence rate and shorter operative time compared with cold-knife technique. |
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