Combined application of ureteroscopy and renal fascial dilator [Abstract] Purpose: To investigate the effective treatment of urethral stricture. METHODS:A guidewire was placed after examination of the posterior urethra into the bladder, and 16 patients with posterior urethral stricture were treated by gradual dilation with a fascial dilator under the guidance of the guidewire. Results: 16 patients were successfully dilated in one stage, 2 cases had intermittent postoperative urethral dilatation for half a year, 14 cases were dilated 3-5 times after surgery, and the cure rate was 87.5%. Conclusion: Ureteroscopy combined with renal fascia dilator for posterior urethral stricture is easy to operate, with few complications, no bleeding, reliable efficacy and low recurrence rate, and is worth promoting. Urethral stricture is a common disease in urology, and its treatment methods are various, but ultimately, stricture dilatation to establish access is still preferred. Since August 2005, our hospital started to improve the traditional urethral dilatation by putting a guidewire into the bladder under direct ureteral vision and applying a renal fascial dilator along the guidewire to dilate the urethra one by one, and obtained satisfactory results after the operation, which are reported below. 1 Data and methods 1.1 General data A total of 16 patients with posterior urethral stricture were admitted to our hospital from August 2005 to June 2009, all of whom were male, aged 23-72 years. The causes of stenosis were traumatic stenosis of pelvic fracture in 10 cases, post-TURP stenosis in 4 cases, and inflammatory stenosis after indwelling urinary catheter in 2 cases. 1.2 Treatment method Continuous epidural anesthesia was used. Patients were placed in a truncated position. The ureteroscope was used to enter the urethra under direct vision with Wolf F8/9.8 ureteroscope, and the perfusion pump was used to pressurize the lumen, and the mudskipper guidewire was placed after the lumen was seen under the scope. The ureteroscope was passed along the guidewire through the stenosis ring all the way into the bladder, and the initial dilatation was performed, and the ureteroscope was withdrawn, and then the renal fascial dilator made by F8-18 American cook company was used to dilate step by step. The urethra is then dilated to pass through the F24-26 gauge probe by applying a common metal urethral dilator. If necessary, the urethra was observed with a No. F25 electroscope, which showed that the stricture ring had been dilated and no false tract was formed. Protruding scars and elevated bladder neck orifice were excised and a double-lumen urethral catheter, No. F22, was left in place postoperatively and removed after 2-3 months. After removal of the urethra, a metal dilator was used to intermittently dilate the urethra at the 1st, 3rd, and 6th postoperative weeks for 3-5 consecutive times, respectively. If there was no retraction of urethral stricture and the symptoms improved significantly, it was considered as a cure. 2 Results All 16 cases in this group were successfully dilated in one phase without complications of urethral perforation. 2 cases showed no significant improvement in symptoms after dilatation, and improvement was considered as improvement after six months of dilatation compared with the preoperative period. The cure rate was 87.5%, and no recurrence was found during the follow-up period of 6 months to 1 year. 3 Discussion The causes of urethral stricture are often traumatic, inflammatory, medical and congenital. With the widespread development of endoluminal techniques in clinical practice and the continuous changes in open surgery, the treatment pathways for urethral stricture have been broadened and the treatment methods have been diversified, which has improved the cure rate of urethral stricture [1]. Although most people now consider endourethrotomy and scar resection under direct speculum view as the treatment of choice for traumatic urethral strictures [2]. However, it still causes some thermal damage to the urethra, and urethral dilation after channel establishment still has a definite role in urethral strictures [3]. Traditional urethral dilatation with urethral probes is blind, and the urethral probes often have difficulty passing through the stricture and make urethral dilatation fail. In addition, it is easy to damage the urethral mucosa and aggravate the degree of stricture, and may even cause complications such as pseudo-duct and urethro-rectal fistula. With the continuous development of lumpectomy treatment, we have improved the traditional blind dilation to dilation under the guidance of guidewire, which avoids unnecessary medical re-injury. In this group of patients, the urethra was passed through the stenosis ring into the bladder under the direct view of ureteroscope with a mudskipper guidewire, and the guidewire was left in place to exit the ureteroscope, then the kidney fascia dilator No. F8-18 was used to dilate the urethra step by step, and then a common metal urethral dilator was applied to dilate the urethra until it could be passed through the probe No. F24-26, so that the guidewire was placed under direct view to reduce the occurrence of complications such as pseudo-tract formation and mucosal injury. After dilating the stricture, it can also be observed under direct vision with ureteroscopy to determine the exact site and length of the stricture and to understand whether there is any damage to the urethral mucosa for further treatment. The technical point of this method is that the mudskipper guidewire is passed through the stenosis ring under direct vision, and the deep fascia dilator is passed through the stenosis ring by rotating along the guidewire after leaving the guidewire, and after dilating to F18 number, the normal urethral probe is used to dilate instead, which can avoid the re-injury to the urethral mucosa caused by blind dilatation, and can avoid the formation of pseudo-tract, which has the advantages of safety, small trauma, high success rate, and can be used repeatedly, and is worthy of further It is worth to further promote the application.