Department of Urology, Tanta University, Tanta, Egypt.
J Endourol. 2009 Dec;23(12):2001-5. doi: 10.1089/end.2009.0074.
The objective of this study was to evaluate the results of internal urethrotomy with endoscopically placed small intestinal submucosa (SIS) graft for treatment of selected cases of recurrent urethral stricture.
This prospective study included 10 patients with recurrent inflammatory bulbar urethral stricture of 0.5-2 cm in length with no dense spongiofibrosis. Following the 12 o'clock visual internal urethrotomy, a prepared 12F Foley's silicon catheter with the SIS patch was introduced into the urethra over a preplaced super-stiff guidewire. The advancement of this catheter was monitored via a 15F urethroscope to enable us to put its balloon with the overlying SIS patch at the site of the urethral incision. Thereafter, the balloon was inflated with saline and the catheter was secured with a silk suture to the glans. In addition, a suprapubic cystostomy was fixed for bladder drainage. These catheters were kept in place for 2 weeks. The patients were followed up at regular intervals using uroflowmetry and ascending urethrography.
At 3-month follow-up, only two cases showed mild recurrent stricture and the rest of cases had a normally patent functional urethra. The subsequent follow-up studies of all the eight successful cases for 12-18 months revealed no evidence of recurrent stricture in all of them and no more interventions were required for any of them. On the other hand, the two cases with recurrent stricture showed a satisfactory response to regular monthly urethral dilatation.
Endoscopic urethroplasty using SIS patch can be considered as a minimally invasive solution for cases with recurrent, short urethral stricture that are associated with mild spongiofibrosis.
本研究旨在评估经内镜放置小肠黏膜下层（SIS）移植物的尿道内切开术治疗复发性尿道狭窄的疗效。
本前瞻性研究纳入了 10 例长度为 0.5-2cm 的复发性炎症性球部尿道狭窄患者，且无致密的海绵纤维变性。在 12 点可视尿道内切开术后，将准备好的带有 SIS 补丁的 12F Foley 硅导管通过预先放置的超硬导丝引入尿道。通过 15F 尿道镜监测此导管的推进情况，以便将其球囊和覆盖的 SIS 补丁置于尿道切口部位。此后，用生理盐水充盈球囊，并将导管用丝线固定在龟头。此外，耻骨上膀胱造口术用于固定膀胱引流。这些导管留置 2 周。定期通过尿流率和上行尿道造影对患者进行随访。
在 3 个月的随访中，仅 2 例出现轻度复发性狭窄，其余病例的功能性尿道均正常通畅。对 8 例成功病例进行的后续 12-18 个月的随访研究显示，所有病例均无复发性狭窄的证据，且无需对任何病例进行进一步干预。另一方面，2 例复发性狭窄的病例对定期每月尿道扩张有满意的反应。
对于伴有轻度海绵纤维变性的复发性短尿道狭窄病例，内镜尿道成形术使用 SIS 补丁可被视为一种微创解决方案。
