前尿道狭窄的精准诊疗：现状、突破与前瞻

Precision diagnosis and treatment of anterior urethral stricture: current status, breakthroughs, and prospects

摘要

前尿道狭窄是男性泌尿外科常见良性疾病，其诊疗正经历从传统经验模式向精准化、个体化体系的深刻转变。现状方面，诊断方案已形成多模态整合评估体系：超声尿道造影、磁共振尿道造影及人工智能辅助技术显著提升了狭窄形态与功能评估精度；治疗方案则依据2023年美国泌尿外科协会（AUA）指南实施个体化分层策略，短段球部狭窄首选腔内微创联合抗纤维化药物或药物涂层球囊，中长段及复杂狭窄以口腔黏膜尿道成形术为金标准。突破方面，机制研究揭示了转化生长因子-β（TGF-β）信号通路异常激活、基质金属蛋白酶系统失衡及补体级联紊乱在尿道海绵体纤维化中的关键作用，为靶向抗纤维化治疗提供了理论支点；再生医学领域，小肠黏膜下层支架及间充质干细胞注射已初步展现临床可行性，药物涂层球囊5年远期随访数据证实其持续疗效。前瞻方面，人工智能驱动的多模态预测模型将实现术后复发风险的精准分层；3D生物打印技术有望构建仿生尿道替代物，解决长段狭窄修复难题；机器人辅助手术系统在盆底复杂狭窄重建中的应用将逐步普及。综上，前尿道狭窄诊疗正朝着精准评估、微创干预与功能重塑深度融合的方向发展，未来有望进一步降低狭窄复发率、改善患者远期预后。

Abstract

Anterior urethral stricture is a common benign disease in male urology. Its diagnosis and treatment are undergoing a profound transformation from traditional empirical approaches to precise and individualized systems. In terms of current status, a multimodal integrated assessment system has been established for diagnosis: sonourethrography, magnetic resonance urethrography, and artificial intelligence-assisted techniques have significantly improved the accuracy of morphological and functional evaluation of strictures. In terms of treatment, individualized stratified strategies are implemented according to the 2023 American Urological Association (AUA) guidelines. Endoscopic minimally invasive procedures combined with antifibrotic agents or drug-coated balloons are the first choice for short-segment bulbar strictures, while oral mucosa urethroplasty remains the gold standard for medium-to-long segment and complex strictures. In terms of breakthroughs, mechanistic studies have revealed the key roles of aberrant activation of the transforming growth factor-β (TGF-β) signaling pathway, imbalance of the matrix metalloproteinase system, and dysregulation of the complement cascade in urethral spongiosum fibrosis, providing a theoretical basis for targeted antifibrotic therapy. In the field of regenerative medicine, small intestinal submucosa scaffolds and mesenchymal stem cell injection have shown preliminary clinical feasibility, and five-year long-term follow-up data of drug-coated balloons have confirmed their sustained efficacy. In terms of prospects, artificial intelligence-driven multimodal prediction models will enable precise risk stratification for postoperative recurrence. Three-dimensional bioprinting technology is expected to construct biomimetic urethral substitutes to address the challenge of long-segment stricture repair. Robot-assisted surgical systems will gradually gain popularity in the reconstruction of complex pelvic floor strictures. In summary, the diagnosis and treatment of anterior urethral stricture are moving toward a deeply integrated direction of precise evaluation, minimally invasive intervention, and functional restoration, with the prospect of further reducing recurrence rates and improving long-term patient outcomes.

关键词

前尿道狭窄 / 修复重建 / 口腔黏膜尿道成形术 / 再生医学 / 组织工程 / 人工智能 / 机器人手术

Key words

anterior urethral stricture / reconstruction and repair / oral mucosa urethroplasty / regenerative medicine / tissue engineering / artificial intelligence / robot-assisted surgery

参考文献

[1] 司捷旻， 宋鲁杰， 金重睿， 等. 改良Kulkarni法一期舌黏膜尿道成形术治疗前尿道狭窄的疗效[J]. 中华泌尿外科杂志， 2024， 45（10）： 721-726.

[2] FRANKIEWICZ M, VETTERLEIN MW, MARKIET K, et al. Ultrasound imaging of male urethral stricture disease: a narrative review of the available evidence, focusing on selected prospective studies[J]. World J Urol, 2024, 42(1): 32.

[3] LUO H, LOU KC, XIE LY, et al. Pharmacotherapy of urethral stricture[J]. Asian J Androl, 2024, 26(1): 1-9.

[4] 徐涛， 张维宇. GnRH激动剂还是拮抗剂？前列腺癌去势治疗的挑战与优化[J]. 现代泌尿外科杂志， 2025， 30（5）： 367-374.

[5] 赵军. 男性硬化性苔藓样尿道狭窄的诊治策略[J]. 现代泌尿外科杂志， 2024， 29（11）： 941-944， 974.

[6] LI O, COHEN AJ. The future of anterior urethral strictures and urethroplasty in adult men: a narrative review[J]. AME Med J, 2023, 8(12): e9933.

[7] SANKIN A, DAVE P, CHERRILL LR, et al. Low-grade urothelial carcinoma recurs at a tempo that naturally accelerates over time[J]. Urology, 2024, 193: 166-172.

[8] GRIMES MD, TESDAHL BA, SCHUBBE M, et al. Histopathology of anterior urethral strictures: toward a better understanding of stricture pathophysiology[J]. J Urol, 2019, 202(4): 748-756.

[9] GUTIERREZ WR, LUO Y, DAHMOUSH L, et al. Deep phenotyping the anterior urethral stricture: characterizing the relationship between inflammation, fibrosis, patient history, and disease pathophysiology[J]. J Urol, 2024, 212(1): 153-164.

[10] GAO J, LIU H, LI L, et al. Comprehensive proteomic characterization of urethral stricture disease in the Chinese population[J]. Front Mol Biosci, 2024, 11: 1401970.

[11] MINAMI T, HORIGUCHI A, SHINCHI M, et al. Surgical and patient-reported outcomes of staged urethroplasty for anterior urethral strictures: a comprehensive analysis[J]. Int J Urol, 2025, 32(4): 441-446.

[12] 黄海， 彭世荣. 中国人口老龄化背景下老年尿失禁早期干预的挑战及前景[J]. 现代泌尿外科杂志， 2025， 30（4）： 275-278.

[13] CHAPMAN D, KINNAIRD A, ROURKE K. Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures[J]. J Urol, 2017, 198(5): 1107-1112.

[14] WONG HP, SO WZ, FONG KY, et al. Advances in urethral stricture diagnostics and urethral reconstruction beyond traditional imaging: a scoping review[J]. Cent Eur J Urol, 2022, 75(3): 528-535.

[15] EUROPEAN ASSOCIATION OF UROLOGY. Urethral strictures: EAU guidelines. 2023. https://uroweb.org/guidelines/urethral-strictures. Accessed May 10, 2026.

[16] WESSELS SG, HEYNS CF. Prospective evaluation of a new visual prostate symptom score, the international prostate symptom score, and uroflowmetry in men with urethral stricture disease[J]. Urology, 2014, 83(1): 220-224.

[17] 白志明. 共存的膀胱过度活动-膀胱活动低下症——一个下尿路症状的新综合征[J]. 现代泌尿外科杂志， 2024， 29（10）： 852-854， 864.

[18] SEHGAL N, PRIYADARSHI V. Impact of adding urethral sonography with retrograde urethrography in preoperative assessment of anterior urethral stricture[J]. J Med Ultrasound, 2024, 32(3): 209-214.

[19] CHEN L, FENG C, LV XG, et al. Three-dimensional computerized model based on the sonourethrogram: a novel technique to evaluate anterior urethral stricture[J]. J Urol, 2018, 199(2): 568-575.

[20] FENG C, LU QJ, XUE JD, et al. Optimizing anterior urethral stricture assessment: leveraging AI-assisted three-dimensional sonourethrography in clinical practice[J]. Int Urol Nephrol, 2024, 56(12): 3783-3790.

[21] HENZ CONCATTO N, SCHUCH A, DE OLIVEIRA CAETANO T, et al. Multiparametric MR urethrography: dynamic comprehensive evaluation of the male urethra[J]. Radiographics, 2025, 45(9): e240164.

[22] KUCUKER K, DUZGUN D, SAGLAM B, et al. The role of magnetic resonance imaging in preoperative evaluation of anterior obliterative urethral strictures[J]. Diagnostics (Basel), 2025, 15(19): 2415.

[23] REVELS JW, WANG SS, WEAVER JS, et al. A multimodality review of male urethral imaging: pearls and pitfalls with an update on urethral stricture treatment[J]. Br J Radiol, 2022, 95(1134): 20211034.

[24] TOKUC E, EKSI M, KAYAR R, et al. Inflammation indexes and machine-learning algorithm in predicting urethroplasty success[J]. Investig Clin Urol, 2024, 65(3): 240-247.

[25] ALTINTAS E, ŞAHIN A, BABAYEV H, et al. Machine learning algorithm predicts urethral stricture following transurethral prostate resection[J]. World J Urol, 2024, 42(1): 324.

[26] AMERICAN UROLOGICAL ASSOCIATION. Urethral stricture disease guideline. 2023 [EB/OL]. https://www.auanet.org/guidelines-and-quality/guidelines/urethral-stricture-guideline. Accessed May 10, 2026.

[27] CABRAL JD, ALKASSIS M, KHALAFALLA K, et al. Contemporary trends in the management of urethral stricture disease in the era of the AUA guidelines[J]. Urology, 2025, 206: 173-179.

[28] CHEN H, YIN F, ZHONG H, et al. Prophylactic adjuvant therapy for postoperative recurrence of urethral stricture: a narrative review[J]. Transl Androl Urol, 2025, 14(10): 3413-3427.

[29] XU C, ZHU Z, LIN L, et al. Efficacy of mitomycin C combined with direct vision internal urethrotomy for urethral strictures: a systematic review and meta-analysis[J]. Urol Int, 2023, 107(4): 344-357.

[30] ESTAPHANOUS P, KHALIFA AO, MAKAR Y. Efficacy and safety of Optilume drug-coated balloon for urethral stricture treatment: a systematic review and meta-analysis[J]. Cureus, 2024, 16(11): e74069.

[31] SOLIMAN C, PAN HYC, MULHOLLAND CJ, et al. Effect of local steroids on urethral strictures: a systematic review and meta-analysis[J]. Investig Clin Urol, 2022, 63(3): 273-284.

[32] CHAPPLE C, ANDRICH D, ATALA A, et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty[J]. Urology, 2014, 83(3 Suppl): S31-S47.

[33] SIMONATO A, GREGORI A, AMBRUOSI C, et al. Lingual mucosal graft urethroplasty for anterior urethral reconstruction[J]. Eur Urol, 2008, 54(1): 79-85.

[34] WANG A, CHUA M, TALLA V, et al. Lingual versus buccal mucosal graft for augmentation urethroplasty: a meta-analysis of surgical outcomes and patient-reported donor site morbidity[J]. Int Urol Nephrol, 2021, 53(5): 907-918.

[35] TAKEKAWA K, HORIGUCHI A, SHINCHI M, et al. One-sided dorsal onlay urethroplasty with penile invagination (Kulkarni urethroplasty) for complex anterior urethral strictures: a single-center experience[J]. Int J Urol, 2025, 32(6): 749-755.

[36] CALVO CI, FENDER K, HOY N, et al. Affirming long-term outcomes after contemporary urethroplasty: the adverse impact of increasing stricture length, lichen sclerosus, radiation, and infectious strictures[J]. J Urol, 2024, 211(3): 455-464.

[37] 罗德毅， 沈宏， 张洁. 从病因治疗到重塑尿控——女性压力性尿失禁的手术治疗观念变更及当前的金标准术式[J]. 现代泌尿外科杂志， 2025， 30（1）： 8-12.

[38] FENG H, HUANG X, FU W, et al. A Rho kinase inhibitor (FASUDIL) suppresses TGF-β mediated autophagy in urethra fibroblasts to attenuate traumatic urethral stricture (TUS) through re-activating Akt/mTOR pathway: an in vitro study[J]. Life Sci, 2021, 267: 118960.

[39] PALMINTERI E, TOSO S, PRETO M, et al. Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching[J]. World J Urol, 2024, 42(1): 123.

[40] ORTAC M, OZERVARLI MF, TANTEKIN SA, et al. A first-in-human pilot study of Wharton's jelly-derived mesenchymal stem cell injection for urethral stricture: safety and preliminary efficacy[J]. World J Urol, 2026, 44(1): 308.

[41] ESKANDAR K. 3D-bioprinted urethral grafts: revolutionizing urethral stricture treatment[J]. Arab J Urol, 2025, 23(4): 330-340.

[42] MANN RA, VIRASORO R, DELONG JM, et al. Long-term outcomes of recurrent bulbar urethral stricture treatment with the Optilume drug-coated balloon: five-year results from the ROBUST I study[J]. J Urol, 2025, 213(1): 90-98.

[43] MANTICA G, CHIERIGO F, BIAŁEK Ł, et al. The use of robotic surgery for the management of urethral strictures and bladder neck contractures: a systematic review[J]. Actas Urol Esp (Engl Ed), 2025, 49(1): 11-19.