Falandry L, Xie D, Liang Z, Seydou M, Alphonsi R
Service d'Urologie, Centre Hospitalier Universitaire de Niamey, Niger.
J Gynecol Obstet Biol Reprod (Paris). 1999 May;28(2):151-61.
Reported here is our experience with a single or double-face new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. Between January 1992 to July 1997, 56 cases of urethral damage on African female patients, with an average age of 18 years old, were treated by pedicled labial urethroplasty. This procedure was done by using a single or double-face pedicled flap obtained from the major or minor labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were proposed: patch for sufficient lengthening (27 cases), tubularized flap allowing complete reconstruction of the urethra (18 cases) and the double-face urethroplasty (11 cases). Good quality urine continence was obtained by using the sub urethral Martius'sling procedure. In 11 cases, we combined the treatment with a colposuspension procedure. The average follow-up was 23 months (ranging from 5 to 47 months). The global success was 82% (52 patients treated). Recovery of normal miction and absence of urinary leak was obtained in 36 cases (69%). While 7 moderate failures occurred (13%), 9 cases were considered complete failures (17%). In view of the high success rate, we consider that the one-stage procedure by the use of a single or double face pedicled labial flap is a choice treatment and highly suitable for the management of extensive urethral cervical damage after obstetrical injury.
本文报告了我们使用带蒂阴唇皮瓣进行单面或双面新手术，对产科损伤后尿道广泛损伤患者进行尿道重建的经验。1992年1月至1997年7月，对56例非洲女性尿道损伤患者进行了带蒂阴唇尿道成形术治疗，患者平均年龄18岁。该手术通过使用从大阴唇或小阴唇获取的单面或双面带蒂皮瓣来完成。然后将皮瓣像隧道一样引入阴道上皮下方到达受损尿道。提出了多种技术：用于充分延长的补片（27例）、可实现尿道完全重建的管状皮瓣（18例）和双面尿道成形术（11例）。通过尿道下Martius吊带手术获得了良好的尿控。在11例患者中，我们将该治疗与阴道悬吊术相结合。平均随访时间为23个月（5至47个月）。总体成功率为82%（52例接受治疗患者）。36例（69%）患者恢复了正常排尿且无尿漏。7例出现中度失败（13%），9例被认为完全失败（17%）。鉴于高成功率，我们认为使用单面或双面带蒂阴唇皮瓣的一期手术是一种选择治疗方法，非常适合处理产科损伤后广泛的尿道宫颈损伤。
