儿童前尿道狭窄病因、诊断评估与治疗策略研究进展

Research progress on the etiology, diagnostic evaluation and treatment strategies of anterior urethral strictures in children

摘要

儿童前尿道狭窄较为少见，其临床表现大多为持续性下尿路梗阻、反复尿路感染、膀胱功能异常，严重者甚至累及上尿路并影响远期泌尿生殖功能。与成人不同，儿童前尿道狭窄以医源性和外伤性病因为主，其中尿道下裂术后狭窄是最具小儿泌尿外科特点且重建难度最高的复杂亚型。儿童前尿道狭窄的诊断应以病史、排尿症状和体格检查为基础，结合尿流率、残余尿、逆行尿道造影、排泄性膀胱尿道造影及必要时行尿道镜检查，并对狭窄部位、病变范围、闭塞程度、海绵体纤维化及局部组织条件进行综合评估。治疗策略应以病因和术前分层为核心：局限性、初发、非闭塞性狭窄可谨慎选择扩张或直视下内切开，但长期疗效有限；局灶性球部狭窄宜优先考虑根治性开放重建；范围较广、复发性、尿道下裂术后或炎症性狭窄常需口腔黏膜替代尿道成形或分期重建。疗效评价不应仅以短期排尿通畅为标准，还应结合排尿症状、尿流率、残余尿及必要时影像学检查进行综合评估，并重视青春期及成年早期的长期功能随访，以识别迟发性梗阻及远期排尿和性相关功能问题。当前儿童前尿道狭窄诊疗领域证据仍以回顾性单中心研究为主，结局指标尚不统一，跨青春期长期随访资料不足。未来应建立更符合儿童特点的分层体系与核心结局指标，并加强多中心前瞻性研究，以优化个体化重建策略和改善长期功能结局。

Abstract

Anterior urethral stricture in children is relatively rare. Its clinical manifestations mainly include persistent lower urinary tract obstruction, recurrent urinary tract infection and bladder dysfunction. In severe cases, it may even involve the upper urinary tract and affect long-term urogenital function. Unlike adult cases, pediatric anterior urethral stricture is predominantly attributable to iatrogenic and traumatic causes, among which post-hypospadias stricture represents the subtype most characteristic of pediatric urology and the most challenging in terms of reconstruction. Diagnosis should be based on a detailed medical history, voiding symptoms, and physical examination, in conjunction with uroflowmetry, post-void residual, retrograde urethrography, voiding cystourethrography, and urethroscopy, so as to provide a comprehensive assessment of stricture location, extent of disease, degree of obstruction, spongiofibrosis, and local tissue conditions. Treatment strategies should be guided primarily by etiology and preoperative stratification. Dilatation or direct visual internal urethrotomy may be cautiously considered for localized, primary, non-obstructive strictures, although their long-term efficacy is limited. Focal bulbar strictures are generally more suitably managed by radical open reconstruction, whereas more extensive, recurrent, post-hypospadias, or inflammatory strictures often require substitution urethroplasty using buccal mucosa or staged reconstruction. Outcome assessment should not rely solely on short-term urethral patency, but also incorporate voiding symptoms, uroflowmetry, post-void residual, and when necessary, imaging evaluation. Long-term follow-up through puberty and early adulthood is essential to identify delayed obstruction as well as long-term voiding and sexual functional outcomes. At present, evidence in the field of pediatric anterior urethral stricture management remains predominantly derived from retrospective single-center studies, outcome measures are not standardized, and long-term follow-up data across puberty are insufficient. Future research should focus on establishing pediatric-specific stratification systems and core outcome measures, as well as strengthening multicenter prospective studies, in order to optimize individualized reconstructive strategies and long-term functional outcomes.

关键词

儿童 / 前尿道狭窄 / 尿道下裂 / 尿道成形术 / 尿流率 / 长期随访

Key words

children / anterior urethral stricture / hypospadias / urethroplasty / uroflowmetry / long-term follow-up

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