Wei Qiang, Liu Jiumin
Department of Kidney Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou Guangdong 510515, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Aug;23(8):937-9.
To investigate the therapeutic effect of pedicled scrotal septal flap urethroplasty on long-segment posterior urethral stricture and to assess its application value.
From January 2003 to December 2007, 24 patients (age range, 6-54 years old) with long-segment urethral stricture underwent pedicled scrotal septal flap urethroplasty. The duration of the disease was 1-5 years. The stricture was caused by traumatic urethral injury or disruption in 22 cases, postoperative complication of suprapubic transvesical prostatectomy in 1 case, and recurrent urethral infection due to long-term indwelling urinary catheter in 1 case. Urethroscopy or cystourethrography examination confirmed that all cases had urethral stricture 2.0-5.5 cm in length. Eleven cases were complicated with urethral false passage, 6 with urethral fistula, 2 with intestinal fistula, and 6 with erectile dysfunction. The result of excretion urography of bilateral upper urinary tracts was negative in all cases. Pedicled scrotal septal flap 2.5 cm x 2.0 cm-6.5 cm x 2.5 cm in size was harvested during operation, and urethroplasty was performed.
Volume of blood loss during operation was 100-500 mL (average 270 mL). The operative time was 90-220 minutes (average 135 minutes). All flaps survived. All wounds healed by first intention. All patients had normal urination after operation. Over the follow-up period of 12-36 months (average 18.6 months), 1 of the 24 patients suffered from urinary incontinence, 2 from urethral stricture, 1 from urethral stricture and urethral fistula, and 1 from urethral diverticulum around the distal anastomosis. Those patients got normal urination after symptomatic treatment. No urethral stone, urinary incontinence, and new case of erectile dysfunction occurred. The maximum urinary flow rate 16 months after operation was 14-21 mL/s (average 17.6 mL/s). Voiding cystourethrography 22 months after operation showed unblocked urinary tract and no formation of stricture and fistula.
Pedicled scrotal septal flap urethroplasty, featured by simple operative method, easy flap harvest, and high survival rate of flap, is one of safe and effective methods for treating long-segment posterior urethral stricture.
探讨带蒂阴囊纵隔皮瓣尿道成形术治疗长段后尿道狭窄的疗效并评估其应用价值。
2003年1月至2007年12月，24例长段尿道狭窄患者（年龄6 - 54岁）接受带蒂阴囊纵隔皮瓣尿道成形术。病程1 - 5年。22例狭窄由外伤性尿道损伤或断裂引起，1例由耻骨上经膀胱前列腺切除术后并发症引起，1例由长期留置导尿管导致的复发性尿道感染引起。尿道镜或膀胱尿道造影检查证实所有病例尿道狭窄长度为2.0 - 5.5 cm。11例合并尿道假道，6例合并尿道瘘，2例合并肠瘘，6例合并勃起功能障碍。所有病例双侧上尿路排泄性尿路造影结果均为阴性。术中切取大小为2.5 cm×2.0 cm - 6.5 cm×2.5 cm的带蒂阴囊纵隔皮瓣，并行尿道成形术。
术中出血量为100 - 500 mL（平均270 mL）。手术时间为90 - 220分钟（平均135分钟）。所有皮瓣均存活。所有伤口一期愈合。所有患者术后排尿正常。在12 - 36个月（平均18.6个月）的随访期内，24例患者中1例出现尿失禁，2例出现尿道狭窄，1例出现尿道狭窄合并尿道瘘，1例出现吻合口远端尿道憩室。经对症治疗后这些患者排尿恢复正常。未出现尿道结石、尿失禁及新的勃起功能障碍病例。术后16个月最大尿流率为14 - 21 mL/s（平均17.6 mL/s）。术后22个月排尿期膀胱尿道造影显示尿路通畅，无狭窄及瘘形成。
带蒂阴囊纵隔皮瓣尿道成形术手术方法简单，皮瓣切取容易，皮瓣成活率高，是治疗长段后尿道狭窄安全有效的方法之一。
