Mathur Raj K, Sharma Adittya K, Odiya Sudarshan
Department of Surgery, M.G.M Medical College and M.Y. Group of Hospitals, Madhya Pradesh, India.
Int J Urol. 2009 Sep;16(9):751-5. doi: 10.1111/j.1442-2042.2009.02356.x. Epub 2009 Aug 5.
To assess the efficacy of tunica albuginea urethroplasty (TAU) for anterior urethral strictures.
We assessed 206 patients with anterior urethral strictures who underwent TAU. The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove with a silicon catheter in situ. Thus in neourethra, the roof is formed by tunica albuginea of the urethral groove. Results were assessed at 6, 12, 24 and 36 months by comparative analysis of patient satisfaction along with retrograde urethrogram, urethrosonogram, uroflowmetry, and were categorized as good, fair and poor. Good and fair results were considered as successful. Thirty patients were taken for postoperative urethroscopic analysis to allow better understanding of both successful and failed cases.
Postoperative evaluation at 6 months showed a 96.6% success rate, which decreased to 94.7% at 1 year, 93.2% at 2 years and over 90% at the end of 3 years. The overall failure rate was 9.2%, which required revision surgery. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra uniformly lined by urothelium over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Failure cases showed diffuse fibrotic narrowing or circumferential scarring.
Tunica albuginea is a locally available distensible tissue, sufficient to maintain the patency of the neourethra, without any graft or flap. TAU is easier and useful when patients have unhealthy oral mucosa due to tobacco chewing.
评估白膜尿道成形术（TAU）治疗前尿道狭窄的疗效。
我们评估了206例行TAU的前尿道狭窄患者。该手术包括游离狭窄尿道并通过背侧切口将其切开。切开的尿道边缘与尿道沟边缘缝合，同时留置硅胶导管。这样，在新尿道中，尿道沟的白膜形成了顶部。在6、12、24和36个月时，通过比较分析患者满意度以及逆行尿道造影、尿道超声、尿流率测定来评估结果，并将其分为良好、一般和差。良好和一般的结果被视为成功。选取30例患者进行术后尿道镜检查，以便更好地了解成功和失败病例。
术后6个月评估显示成功率为96.6%，1年时降至94.7%，2年时为93.2%，3年末超过90%。总体失败率为9.2%，需要进行修复手术。成功病例中，尿道镜检查重建部位显示新尿道宽阔、通畅且可扩张，顶部由海绵体白膜形成，表面均匀覆盖尿路上皮。失败病例显示弥漫性纤维化狭窄或环形瘢痕形成。
白膜是一种局部可用的可扩张组织，足以维持新尿道的通畅，无需任何移植物或皮瓣。当患者因咀嚼烟草导致口腔黏膜不健康时，TAU操作更简便且实用。
