Lopes J F, Schned A, Ellsworth P I, Cendron M
Department of Surgery, Section of Urology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, New Hampshire, USA.
J Urol. 2001 Sep;166(3):1014-7.
Tubularized incised plate urethroplasty has rapidly gained popularity for treating hypospadias. It is presumed that healing occurs with the postoperative migration of epithelial cells into the incised urethral plate. We describe the time course and histology of the healing urethral wound in an animal model after dorsal incision and stenting.
A procedure was developed for use in an immature porcine model. The ventral aspect of the urethra was opened and a dorsal incision was made in the urethra to the level of the corpus spongiosum. The urethra was then catheterized and closed ventrally. Animals were sacrificed at intervals of 1, 2, 3, 5, 7, 14 and 21 days. Slides were made from multiple cross sections taken from each penis, and stained with hematoxylin and eosin, and Masson trichrome before analysis.
Migration of epithelial cells into the dorsal epithelial defect was evident on postoperative day 2 with apparent complete re-epithelialization by postoperative day 5. Regions of increased fibroblastic activity were observed in the subepithelial stroma below the incised area on postoperative day 3 and early collagen deposition was noted in these areas when stained with Masson trichrome. These areas appeared to organize and by postoperative day 21 there was little evidence of increased fibroblastic activity or excess collagen deposition.
Urethral healing after incision and tubularization over a catheter in our model occurred through normal re-epithelialization without excess collagen deposition or scarring.
管状切开尿道板尿道成形术在治疗尿道下裂方面迅速得到普及。据推测，术后上皮细胞向切开的尿道板迁移从而实现愈合。我们描述了在动物模型中，尿道背侧切开并置入支架后愈合尿道伤口的时间进程和组织学变化。
开发了一种用于未成熟猪模型的手术方法。打开尿道腹侧，在尿道背侧切开至海绵体水平。然后将尿道插管并在腹侧关闭。在术后1、2、3、5、7、14和21天间隔处死动物。从每个阴茎获取多个横截面制作玻片，在分析前用苏木精和伊红以及马松三色染色法染色。
术后第2天可见上皮细胞向背侧上皮缺损处迁移，术后第5天明显完全重新上皮化。术后第3天，在切开区域下方的上皮下基质中观察到成纤维细胞活性增加的区域，用马松三色染色法染色时，这些区域可见早期胶原沉积。这些区域似乎逐渐组织化，到术后第21天，几乎没有成纤维细胞活性增加或胶原过度沉积的迹象。
在我们的模型中，经导管切开并管状化后的尿道愈合是通过正常的重新上皮化实现的，没有胶原过度沉积或瘢痕形成。
