事件记录
面试官: 大发娱乐在大发娱乐 Dr. 杰里米·迈尔斯. He is a specialist of urological surgery. 所以,博士. 迈尔斯, what exactly is a 尿道狭窄?
What is a Urethral Stricture?
Dr. 迈尔斯: 好吧,一个 尿道狭窄 is, 很简单, 尿道上的疤痕, 哪个是从膀胱流出阴茎的尿道. 和 it almost exclusively happens in men. It's very rare that it occurs in women. 所以 that's where we deal with it most.
What Causes a Urethral Stricture?
面试官: 和 what can cause some of these scars?
Dr. 迈尔斯: 大多数疤痕是大发娱乐所说的特发性的，也就是说它们是自然产生的. 它们出现在尿道的一个特定区域，阴囊下面. But you can also get the scars from a bad infection, such as a sexually transmitted disease, 这是非常罕见的. 和 you can also get it from trauma. 最典型的创伤就是男人的会阴部, like on a rail skateboarding or snowboarding.
面试官: 对，马鞍伤，我也读过，对吧? 骑马?
Dr. 迈尔斯: 完全正确. 在西方，大发娱乐从骑马和atv上看到这一点. 和, 有时, it's accompanied by a pelvic fracture when it arises from trauma, 但 this is a small portion of the strictures. Almost all of them just arise for no known reason.
What are the Symptoms of a Urethral Stricture?
面试官: Since these structures are 种 internal, and it's not something you necessarily see, 一个人或一个人如何, 种 . . . 如何 . . . What are some of the symptoms of having a stricture?
Dr. 迈尔斯: The strictures are pretty rare, 所以他们经常被误诊或者在一段时间内没有被发现. 我记得有一次和一位内科医生交谈，他们说，“哦，我甚至没有意识到会发生这种情况.“因此，对于整个医学界来说，它们并不是很受关注. 所以病人通常被诊断为前列腺感染或排尿功能障碍或尿路感染, and then their symptoms don't get better, and then they're sent to a urologist who can diagnose the stricture.
面试官: So, 本质上, 他们有排尿困难和其他并发症，因为尿道实际上更小或不灵活, 是这样吗？?
Dr. 迈尔斯: 完全正确. The urethra narrows down in a lot of cases just to a pinpoint, 所以, the most obvious symptom of that is a very slow flow. 和 most guys will tolerate a slow flow alone. But there's a lot of other symptoms that come up. Men can have urinary tract infections. 然后还有, 他们的膀胱僵硬，因为它对伤疤的挤压太大了，所以他们不得不更频繁地小便，可能有尿急. 所以, a guy might be up four or five times a night urinating, and it may just be due to the blockage.
面试官: 所以，如果它经常被误诊，那么怎样才能真正诊断出一个合适的狭窄呢?
How are Urthral Strictures Diagnosed?
Dr. 迈尔斯: 好吧, the suspicion is increased for a urologist in a younger man, who really should be voiding very well. In older men, the symptoms may be attri但ed to a large prostate. 这很常见. 但在年轻人身上，大发娱乐可以根据他们的血流来诊断或怀疑. 所以, when someone comes to a urologist, 大发娱乐通常让它们在一个特殊的厕所里小便，这样大发娱乐就可以测量它们的流量, and if they have a very slow flow and they're a younger man, 那就很可疑了. 他们可能会有伤疤. 和 where we go from there is pretty variable. 尿道狭窄可以用特殊的x光片来诊断, 或者更常见的, a urologist has a scope that's flexible just like a catheter, 他会通过的, 或者她会把镜穿过尿道然后就能看到疤痕了. 和 that's a very easy way of diagnosing the scar.
尿道狭窄 Treatment Options
面试官: So after it's been diagnosed, 有哪些治疗方法可以缓解这些人的症状呢?
尿道切开术
Dr. 迈尔斯: The options basically fall into a couple categories. 一种是用瞄准镜切开或切开疤痕，这就是 . . . 医学术语是扩张术或尿道切开术，它们的作用是一样的. 本质上, 泌尿科医生将镜送到疤痕区域，然后使用扩张器依次拉伸疤痕并将其打开, 或者他们会从他们能看到的范围里拿出一把小刀，他们会像切梅赛德斯标志一样切伤疤.
通常, 在这之后, a patient will have a catheter for a few days, and then the catheter is removed. 大发娱乐的希望是拉伸或切割疤痕尿道会在导管上愈合愈合到一个合理的大小病人不会有任何症状. 扩张术或内切术的不幸之处在于很少成功, and it probably only works in maybe 20% to 30% of cases. The studies on it are pretty mixed about its success rate. 所以这是微创性的你只需在短时间内插入导管, and it just uses a scope in the urethra. But, un幸运的是, it's rarely a long-term solution for men.
尿道成形术手术
所以大发娱乐治疗尿道狭窄的另一种方法是做一个实际的手术, 大发娱乐在哪里切开尸体, and that's called a urethroplasty surgery. 和 that's what we specialize at the University of Utah in. 本质上, the idea of a urethroplasty is we cut over the scar in the body, 这是 mostly in the perineum, 这是 the area between the anus and the scrotum, 然后大发娱乐非常小心地找到疤痕的区域通过把导管穿过阴茎然后感觉导管停在尿道内的地方. 和 then we cut out the area of the scar, 大发娱乐在尿道的两端之间建立了一个非常好的连接或吻合，它被释放并伸展. 和 that cures the stricture.
所以这个手术可能需要2到4个小时取决于手术的方式和要求. 和 the catheter has to be in a longer time, 你们可以想象阴囊下面的切口会很痛. 所以它's much more invasive, 但 it's also much more successful. 和 the success rates of those surgeries are about 80% to 90%, just depending on the types of surgeries.
手术恢复时间
面试官: 好吧, that's significantly better results then. 和 how long of a healing process is that?
Dr. 迈尔斯: So, 通常, the catheters are in for anywhere from two to four weeks, 这取决于结构的性质以及需要做些什么来修复它. 所以, 在那段时间里, the catheter is really pretty uncomfortable, and most men will be off work 在那段时间里, or if they do non-physical work, they can maybe go back to work after a couple of weeks. The recovery is not like a hernia, so you can't tear open the repair 但, 通常, 当导管插入时, 因为导管的不舒服，男人根本不想做任何身体上的运动. 所以我想说，男性真正感觉好多了的实际恢复时间是一个月左右, and that's why it's much more invasive than the internal cutting, where the recovery really is just five or seven days.
病人的前景
面试官: 所以它, 你知道, 这是一种侵入性手术, and it sounds like there's going to be a bit of a recovery, 但, 你知道, 当一切尘埃落定, 你知道, what are some of the satisfaction rates of some of your patients?
Dr. 迈尔斯: 实际上，大发娱乐在犹他州已经很好地研究了这个问题并与国内其他一些中心进行了合作, and if you look at satisfaction with a surgery, 87%的男性对手术满意或非常满意. 和, 大多数时候, when they're not satisfied with surgery, they have some side effects, such as a sexual side effect, 这是, 幸运的是, pretty rare or the surgery fails them and, 很明显, you wouldn't be satisfied with the result. 所以这是一个非常 . . . 当男性考虑进行侵入性手术时，一个强有力的数字是85%或更多的人对结果感到满意或非常满意.
Another thing that men experience is their urinary symptoms, 一些男性也有很多与狭窄有关的焦虑和抑郁. 和 this can be anxiety about not being able to urinate, 没有男性的正常功能，或者在公共浴室里感到焦虑，或者迫切需要找到厕所. 患有狭窄的男性患抑郁症和焦虑症的几率要高得多. 大发娱乐做了一项研究表明这些比率在狭窄手术后恢复正常并得到改善. So, overall, a lot of things get better. The urinary symptoms get better after the surgery. 所以这是一个很好的手术，尽管没有人会想要做这样的手术. 这是一个非常私人和私密的地方，但它确实很确定地解决了问题.