Da Silva Eloísio Alexsandro, Schiavini João Luis, Santos João Bosco Pinheiro, Damião Ronaldo
Laboratory for Translational Research in Urology, Service of Urology, Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.
J Urol. 2008 Nov;180(5):2042-6. doi: 10.1016/j.juro.2008.07.032. Epub 2008 Sep 18.
Meticulous excision of the stricture and any associated spongiofibrosis is critical to the success of urethral reconstruction. However, normal urethral limits are determined during surgical reconstruction based on macroscopic appearance only. We evaluated structural changes of the presumed healthy urethral ends.
Samples were obtained from 29 patients with a mean age of 40 years who underwent end-to-end anastomotic urethroplasty. Suprapubic catheter drainage was performed for at least 30 days in 15 patients. After the urethral stricture was excised biopsy was performed of the proximal and distal healthy ends. Structural characterization was evaluated by staining histological sections with Masson's trichrome, Sirius red and Weigert's resorcin-fuchsin method. The control group consisted of 10 cadaver bulbar urethras.
All samples of presumed normal urethral ends showed histological changes. Chronic and acute inflammatory reactions were the most common findings. In the proximal urethral end intense cellularity was found in 18 patients (62.1%). Fibroblast and inflammatory cells were most common and related to the lack of suprapubic cystostomy (p = 0.001). Between proximal urethral edges with and without a suprapubic urinary catheter the elastic fiber distribution and the ratio of collagen types III and I showed a significant change (p = 0.045 and <0.001, respectively).
The supposedly healthy urethral ends of end-to-end anastomotic urethroplasty show structural changes. Urethral obstruction and its relief by suprapubic urinary drainage can affect extracellular matrix turnover regulation. Therefore, these changes can lead to urethral remodeling in the proximal bulbar urethra.
精确切除狭窄段及任何相关的海绵体纤维化对于尿道重建的成功至关重要。然而，在手术重建过程中，正常尿道界限仅基于宏观外观来确定。我们评估了假定健康的尿道断端的结构变化。
从29例平均年龄40岁、接受端端吻合尿道成形术的患者中获取样本。15例患者进行耻骨上膀胱造瘘引流至少30天。切除尿道狭窄后，对近端和远端健康断端进行活检。通过用Masson三色染色法、天狼星红染色法和魏格特间苯二酚品红法对组织切片进行染色来评估结构特征。对照组由10个尸体球部尿道组成。
所有假定正常的尿道断端样本均显示组织学变化。慢性和急性炎症反应是最常见的发现。在近端尿道断端，18例患者（62.1%）发现细胞密集。成纤维细胞和炎症细胞最为常见，且与未行耻骨上膀胱造瘘有关（p = 0.001）。在有和没有耻骨上导尿管的近端尿道边缘之间，弹性纤维分布以及III型和I型胶原的比例显示出显著变化（分别为p = 0.045和<0.001）。
端端吻合尿道成形术假定健康的尿道断端显示出结构变化。尿道梗阻及其通过耻骨上尿液引流缓解可影响细胞外基质周转调节。因此，这些变化可导致近端球部尿道的尿道重塑。
