Yang Yong, Xu Yong, Song Yong, Xu A-xiang, Wang Xiao-xiong, Hong Bao-Fa
Department of Urology, General Hospital of the Chinese People's Liberation Army. Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2007 Jun 26;87(24):1693-4.
To assess the value of acellular dermal matrix allograft (ADMA) in surgical treatment of vesico-vaginal fistula (VVF) and anterior urethral stricture.
Four patients suffering from vesico-vaginal fistula and 5 cases with long anterior urethral stricture received surgical treatment in which ADMA were applied. In the VVF patients the ADMA inserted between the vagina and the bladder during transabdominal extraperitoneal repair. In the patients with anterior urethral stricture the ADMA was sutured to substitute the urethra after resection of the stenosis segment.
No intraoperative or postoperative complications occurred. Immediate stoppage of urine leakage from the vagina was seen in the 4 VVF patients, and no recurrence was found during the follow-up of 4 - 12 months. Satisfactory voiding was achieved immediately after removing the catheter in 3 of the 5 cases of urethral stricture, although 2 of the 5 needed urethral sounding for about 2 months. Three months postoperatively all patients were voiding well and their urine flow rates were all normal. Urethrography revealed excellent caliber of the reconstructed urethra.
In plastic surgery of lower urinary tract such as for VVF and urethra stricture, the ADMA may serve as an ideal replacement material for autologous tissue. Its usage avoids the need to harvest autologous tissue, thus providing a novel, safe, effective, microinvasive and economic method in urologic plastic surgery.
评估同种异体脱细胞真皮基质（ADMA）在膀胱阴道瘘（VVF）及前尿道狭窄手术治疗中的价值。
4例膀胱阴道瘘患者和5例前尿道长段狭窄患者接受了应用ADMA的手术治疗。对于膀胱阴道瘘患者，在经腹腹膜外修补术中将ADMA置于阴道与膀胱之间。对于前尿道狭窄患者，在切除狭窄段后将ADMA缝合以替代尿道。
术中及术后均未发生并发症。4例膀胱阴道瘘患者术后阴道立即停止漏尿，在4至12个月的随访中未发现复发。5例尿道狭窄患者中有3例在拔除导尿管后立即排尿通畅，尽管其中2例需要进行约2个月的尿道扩张。术后3个月所有患者排尿良好，尿流率均正常。尿道造影显示重建尿道管径良好。
在膀胱阴道瘘和尿道狭窄等下尿路整形手术中，ADMA可作为自体组织的理想替代材料。其应用避免了自体组织取材的需求，从而为泌尿外科整形手术提供了一种新颖、安全、有效、微创且经济的方法。
