Seitz Michael, Liedl Bernhard, Becker Armin, Gratzke Christian, Reich Oliver, Stief Christian
Department of Urology, University Hospital Munich Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
World J Urol. 2009 Oct;27(5):667-72. doi: 10.1007/s00345-009-0385-1. Epub 2009 Mar 4.
Open surgery on bulbar urethral strictures has become a widespread procedure. While there is inconsistency which procedure to perform at the bulbar region, there is consistency of the used incisional approach despite of several potential disadvantages. Therefore, to bypass disadvantages, we performed an upper transverse scrotal approach for stricture repair in the pendulous urethra and the distal bulbar urethra as previously reported for the placement of an artificial urinary sphincter.
Thirteen patients (n = 13) with bulbar urethral stricture were operated by upper transverse scrotal incision approach. On five patients a free foreskin graft in dorsal onlay technique was performed. Eight patients obtained an end-to-end-anastomosis procedure. Pre- and postoperative uroflowmetry as well as retrograde urethrocystography were done. Pre- and postoperative residual postvoid urine were estimated by transabdominal ultrasound. The patients were followed-up for up to 12 months.
After stricture repair, Qmax improved from mean 9.0 mL/s (SD +/- 3.2) preoperatively to mean 20.3 mL/s (SD +/- 3.1), postoperatively. Postvoid residual urine decreased from mean 90.0 mL (SD +/- 68.7) to mean 41.5 mL (SD +/- 16.1). All retrograde urethrocystographies showed regular reconstructed urethral conditions.
The upper transverse scrotal incision may combine the advantages of a less traumatical approach with the excellent results of perineal approach.
球部尿道狭窄的开放手术已成为一种广泛应用的术式。虽然在球部区域实施何种手术存在不一致性，但尽管存在一些潜在缺点，所采用的切口入路却是一致的。因此，为了规避缺点，我们采用上横阴囊入路对悬垂部尿道和球部尿道远端的狭窄进行修复，该入路如先前报道的用于人工尿道括约肌植入一样。
13例球部尿道狭窄患者采用上横阴囊切口入路进行手术。5例患者采用背侧覆盖技术行游离包皮移植。8例患者进行端端吻合术。术前和术后均进行尿流率测定以及逆行尿道膀胱造影。经腹部超声估计术前和术后排尿后残余尿量。对患者进行长达12个月的随访。
狭窄修复后，最大尿流率（Qmax）从术前平均9.0 mL/s（标准差±3.2）提高到术后平均20.3 mL/s（标准差±3.1）。排尿后残余尿量从平均90.0 mL（标准差±68.7）降至平均41.5 mL（标准差±16.1）。所有逆行尿道膀胱造影均显示重建尿道情况正常。
上横阴囊切口可能兼具创伤较小的入路优势和会阴入路的良好效果。
