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Die bulbäre Harnröhrenstriktur

Banale urologische Erkrankung oder chirurgische Herausforderung?

Bulbar urethral strictures

A trivial urological disease or a surgical challenge?

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Zusammenfassung

Harnröhrenstrikturen befinden sich in der Mehrzahl der Fälle in der bulbären Harnröhre und sind dort meistens durch ein Trauma bedingt. Sie können radiologisch einfach und sicher diagnostiziert werden. Bei kurzstreckigen Erstbefunden kann eine einfache Sachse-Urethrotomie bereits zu einer dauerhaften Sanierung der Erkrankung führen. Im Falle eines Rezidivs sollte jedoch ein offen-operatives Verfahren angewendet werden, da ansonsten keine Heilung mehr erreicht werden kann. Dabei kommen in Abhängigkeit vom Befund und der Begleiterkrankungen die End-zu-End-Anastomose, die Graft- oder Flap-Urethroplastik oder die perineale Urethrostomie in Frage. Bei Verzögerung der offen-chirurgischen Therapie kommt es zu einer Aggravierung des Befunds und zu einer Verschlechterung der Prognose der Erkrankung – unabhängig von der dann angewendeten Therapie.

Abstract

Urethral strictures are often located in the bulbar urethra, and bulbar strictures are commonly due to urethral trauma. Diagnosis is confirmed by radiographic imaging of the urethra. In cases of short primary bulbar strictures, a simple internal urethrotomy may be curative. In contrast, open surgery should be performed in long segment or recurrent strictures because recurrence rates are near 100% in these cases. Depending of the actual findings and comorbidities, end-to-end anastomosis, graft urethroplasty, flap urethroplasty, or perineal urethrostomy may be used. If definitive treatment using open surgery is delayed and multiple endoscopic treatments are tried, urethroplasty becomes more complex and success rates of definitive treatment decline.

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Authors and Affiliations

  1. Klinik für Urologie und urologische Onkologie, Loretto-Krankenhaus Freiburg, Mercystraße 6–14, 79100, Freiburg, Deutschland

    M. Austen & J. Breul

  2. Urologische Klinik und Poliklinik, Klinikum Großhadern, LMU München, München, Deutschland

    S. Tritschler

Authors
  1. M. Austen
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  2. J. Breul
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  3. S. Tritschler
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Correspondence to M. Austen.

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M. Austen, J. Breul und S. Tritschler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Austen, M., Breul, J. & Tritschler, S. Die bulbäre Harnröhrenstriktur. Urologe 57, 17–20 (2018). https://doi.org/10.1007/s00120-017-0545-7

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