The Clinical Study Of The Transurethral Bipolar Plasmakinetic Vaporization Of Urethral Stricture

Objective1. To research the clinical efficiency and feasibility of transurethral bipolar vaporization of urethral stricture(TUBVUS).2. To observe the degree of damnification and cicatrization of bipolar vaporization to compare with the traditional monopole vaporization for skin, kidney and liver.3. To provide opinion impersonally and scientifically for the clinical application of TUBVUS.4. To observe the common complications of TUBVUS.5. To provide opinion impersonally and scientifically for the clinical other application of bipolar vaporization resection.Method: The study includes experimental part and clinical part.1. Experimental part: Study the pathological changes of local tissue after undergoing monopole vaporization and bipolar plasma kinetic vaporization in two conditions.2. Clinical part: From February 2002 to February 2004, 24 patients with US underwent transurethral bipolar plasma kinetic vaporization. The mean stricture length was 1.7cm (range 0.5-3.5cm). The stricture was located in the membranous, bulbar, and penile urethra in 15, 3, and 6 patients. Followup was 1 to 25 months, 5 patients followup in hospital, 13 patients followup with letter and 6 patients followup with telephone. Results:1. TUBVUS is a safe and effective treatment, the operation is simple and repeatable, this technique may reduce the recurrence rate and other complications.2. Experimental part: When the bipolar plasma kinetic works on thelocal tissue, the tissue surface will be vaporized and deeper tissue will coagulate forming the so-called coagulated layer. Beneath coagulated layer, the tissue is injured which is called injured layer connectting with the deeper normal local tissue. The differences between the three groups have statistical significance.The injury of local tissue were severity, rehabilitation were diffecult and cicatrisation were severity.3. Clinical part: From February 2002 to February 2004, 24 patients with US underwent transurethral bipolar plasma kinetic vaporization. The mean stricture length was 1.7cm (range 0.5-3.5cm). The stricture was located in the membranous, bulbar, and penile urethra in 15, 3, and 6 patients. Followup was 1 to 25 months, 5 patients followup in hospital, 13 patients followup with letter and 6 patients followup with telephone. Stricture-free rate in 2 year was 79.2% after TUBVUS, recurrence rate was 20.8%. 3 patients had documented lower urinary tract infections which were cleared with antibiotics whthin 7 days, temporary incontinence was found in 1 patients and cured with exercise of urethral intrinsic sphincter. Conclusion1. TUBVUS is a safe and effective treatment, the operation is simple and repeatable, this technique may reduce the recurrence rate and other complications.2. Bipolar high frequent electrical current produces plasmakinetic in saline media. Plasmakinetic can make specific "cool ablation" on local tissue and form so-called "coagulated layer". Clincal effect of TUBVUS is better than traditional TUMVUS in hemostasia.3. TUBVUS may reduce the recurrence rate and other complications, longer followup is needed to evaluate definitive results and complication.