Armenakas Noel A, McAninch Jack W
Department of Urology, New York Presbyterian Hospital, Weill Medical College of Cornell University and Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021-1883, USA.
Urol Clin North Am. 2002 May;29(2):477-84. doi: 10.1016/s0094-0143(02)00050-2.
The correction of strictures involving the fossa navicularis poses a distinct reconstructive challenge. Unlike surgical repair of strictures involving other urethral segments where the primary concern is restoration of urethral patency, management of fossa navicularis strictures also requires particular attention to cosmesis. Paramount to the success of any of the described procedures is the careful selection of nondiseased tissue for substitution. If the penile skin is healthy, the preferred urethral substitute is the fasciocutaneous ventral transverse island flap. The inherent characteristics of this versatile flap (i.e., well-vascularized predictable pedicle, nonhair bearing, negligible contraction) provide for an excellent time-tested glandular urethral substitute. In rare cases in which there is a suggestion of penile skin inflammation or scarring, extragenital tissue transfer techniques should be considered. Equally important is the need to substitute the entire length of diseased urethra, preferably as an onlay, preserving the dorsal urethral wall. Persistent proximal urethral disease will eventually result in further stricture formation. Finally, the choice of glanduloplasty is particularly important in achieving a cosmetically appealing outcome. A glans-cap repair is preferred because of the limited dissection required with this relatively simple and bloodless technique. Careful selection of the most appropriate combined urethral substitution and glans reconstruction techniques, as well as meticulous attention to surgical details, are mandatory for achieving a satisfactory functional and cosmetic outcome with fossa navicularis strictures.
涉及舟状窝狭窄的矫正带来了独特的重建挑战。与涉及其他尿道节段的狭窄手术修复不同，后者主要关注尿道通畅的恢复，而舟状窝狭窄的处理还需要特别注意美观。任何所述手术成功的关键是仔细选择无病变的组织进行替代。如果阴茎皮肤健康，首选的尿道替代物是筋膜皮腹侧横行岛状皮瓣。这种多功能皮瓣的固有特性（即血运良好、蒂部可预测、无毛发生长、收缩可忽略不计）使其成为经过时间考验的优质尿道替代物。在极少数怀疑有阴茎皮肤炎症或瘢痕形成的情况下，应考虑采用生殖器外组织转移技术。同样重要的是，需要替代整个病变尿道的长度，最好采用覆盖法，保留尿道背侧壁。近端尿道疾病持续存在最终会导致进一步的狭窄形成。最后，龟头成形术的选择对于获得美观的效果尤为重要。由于这种相对简单且无血的技术所需的解剖有限，因此首选龟头帽修复术。仔细选择最合适的联合尿道替代和龟头重建技术，以及对手术细节的精心关注，对于舟状窝狭窄获得满意的功能和美观效果是必不可少的。
