Mathur Raj K, Adittya K Sharma, Jitendra Grover
Department of Surgery, MY Hospital and MGM Medical College, Indore, Madhya Pradesh, India.
Asian J Surg. 2009 Jul;32(3):151-6. doi: 10.1016/s1015-9584(09)60386-9.
To evaluate efficacy of "U" shaped prostatobulbar anastamosis [USPBA] in a posterior urethral stricture along with its urethroscopic evaluation to let us assess the process of neourethrisation in successful cases as well as pathogenesis of restricture in failure cases.
We analysed results of "U" shaped prostato-bulbar anastamosis in 132 patients with posterior urethral stricture, preoperatively and postoperatively with a retrograde urethrogram, urethrosonogram, uroflowmetry and patient satisfaction (based on symptoms). With comparative analysis, results were categorised as good, fair and poor. Twenty patients were randomly selected for urethroscopic evaluation to directly visualise the anastomotic site.
Good and fair results were counted as successful. On immediate postoperative evaluation the success rate was 96.2%, which remained almost the same at 6 months but decreased to 92.42% at 12 months and 90.9% at 24 months. Urethroscopy showed mucosal covering at the area of the roof of neourethra in patients having good results with patent and distensible lumen. Cases with fair results showed similar findings except for some narrowing at places and mucosal irregularities. Poor result cases mostly showed dense fibrosis with collapsed lumen or circumferential scarring leading to constricting stricture.
USPBA lacks disadvantages of ring anastamosis and is an effective option for posterior urethral strictures.
评估“U”形前列腺球部吻合术（USPBA）治疗后尿道狭窄的疗效，并通过尿道镜检查评估成功病例的新尿道形成过程以及失败病例狭窄复发的发病机制。
我们分析了132例后尿道狭窄患者行“U”形前列腺球部吻合术的结果，术前及术后通过逆行尿道造影、尿道超声、尿流率测定以及患者满意度（基于症状）进行评估。通过对比分析，结果分为良好、一般和差。随机选择20例患者进行尿道镜检查，以直接观察吻合部位。
良好和一般的结果视为成功。术后即刻评估成功率为96.2%，6个月时几乎相同，但12个月时降至92.42%，24个月时降至90.9%。尿道镜检查显示，效果良好的患者新尿道顶部区域有黏膜覆盖，管腔通畅且可扩张。效果一般的病例有类似表现，但局部有一些狭窄和黏膜不规则。效果差的病例大多表现为致密纤维化，管腔塌陷或环形瘢痕形成导致狭窄。
USPBA没有环形吻合术的缺点，是治疗后尿道狭窄的有效选择。
