Kuyumcuoglu Ugur, Eryildirim Bilal, Tarhan Fatih, Faydaci Gokhan, Ozgül Aydin, Erbay Erkan
Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
J Endourol. 2010 Jan;24(1):63-7. doi: 10.1089/end.2009.0076.
To investigate the efficacy of the antegrade endourethroplasty technique for the management of frequently recurrent vesicourethral anastomotic strictures that develop after retropubic radical prostatectomy.
Between January 2006 and February 2008, endoscopic antegrade urethroplasty was performed in 11 patients with recurrent vesicourethral anastomotic strictures that developed after retropubic radical prostatectomy (RRP). The mean age of the patients was 64.6 years. In the first step of this two-step procedure, the graft bed was prepared by transurethral resection of the vesicourethral anastomotic stricture region. In the next step, after 3 days, an Amplatz sheath was placed in the urinary bladder suprapubically. Then, an endobronchial catheter was inserted from the external urethral meatus and extended out of the body from the suprapubic region through the Amplatz sheath. A graft taken from anteromedial section of the arm was tubularized on the catheter balloon. The graft was placed into the bladder neck antegradely under endoscopic vision. Subsequently, the graft carrier catheter was fixed by previously placed two polypropylene sutures inserted into the proximal and distal part of the stricture zone percutaneously from the perineum. The transurethral catheter was taken out delicately on postoperative day 21.
Urethral patency succeeded in 6 of the 11 (54.5%) patients, and maximum flow rate was more than 13 mL/s in follow-up. Graft necrosis occurred in two patients, and the stricture recurred in three patients in two months postoperatively.
Antegrade endourethroplasty may be a suitable alternative to open surgical reconstruction in selected patients with recurrent bladder neck stricture following RRP. Further studies, including more patients with modifications, are needed to improve the success rate.
探讨顺行性尿道成形术治疗耻骨后根治性前列腺切除术后频繁复发的膀胱尿道吻合口狭窄的疗效。
2006年1月至2008年2月，对11例耻骨后根治性前列腺切除术（RRP）后出现复发性膀胱尿道吻合口狭窄的患者进行了内镜下顺行性尿道成形术。患者的平均年龄为64.6岁。在这个两步手术的第一步中，通过经尿道切除膀胱尿道吻合口狭窄区域来准备移植床。在下一步中，3天后经耻骨上在膀胱内放置一个安普瑞兹鞘。然后，将一根支气管内导管从尿道外口插入，并通过安普瑞兹鞘从耻骨上区域穿出体外。取自手臂前内侧部分的移植物在导管球囊上制成管状。在直视下将移植物顺行置入膀胱颈。随后，通过先前经会阴经皮插入狭窄区近端和远端的两根聚丙烯缝线将移植物载体导管固定。术后第21天小心取出经尿道导管。
11例患者中有6例（54.5%）尿道通畅，随访时最大尿流率超过13 mL/s。2例患者发生移植物坏死，3例患者术后2个月狭窄复发。
对于RRP术后复发性膀胱颈狭窄的特定患者，顺行性尿道成形术可能是开放手术重建的合适替代方法。需要进一步的研究，包括纳入更多患者并进行改进，以提高成功率。
