Department of Urology, University of Texas Southwestern, Dallas, TX 75390-9110, USA.
J Urol. 2010 Dec;184(6):2395-9. doi: 10.1016/j.juro.2010.08.034. Epub 2010 Oct 16.
We compared our experience with the reconstruction of proximal vs distal bulbar stricture to assess the role of excision and primary anastomosis vs graft procedures at each site.
We reviewed all urethroplasties done by a single surgeon during a 2-year period. Data analyzed included patient history and demographics, operative details, stricture length and site, and clinical outcome. The proximal bulbar urethra was defined as the segment within 5 cm of the membranous urethra and the distal bulb was defined as the adjoining segment extending to the penoscrotal junction. Cases involving the pendulous or posterior urethra were excluded from study.
Of 210 urethroplasties from 2007 to 2009, 112 were done for bulbar strictures, including 72 (64%) for proximal bulbar strictures. All 72 cases were treated with excision and primary anastomosis. Median stricture length was 2 cm (range 1 to 5), although 31 of 72 strictures (43%) were of intermediate length (2.5 to 5 cm). Recurrence developed in 1 case (1.4%). Distal bulbar strictures in 40 of the 112 cases (36%) were treated predominantly with substitution urethroplasty in 36 (90%), and with excision and primary anastomosis in 4 (10%). Median stricture length was 3.75 cm (range 1.5 to 20). We noted intermediate length stricture in 18 of 40 cases (45%) and recurrence in 11 (28%). Of intermediate length strictures recurrence was much rarer after excision and primary anastomosis than after graft procedures (1 of 33 or 3.0% vs 6 of 16 or 38%, p<0.05).
Location is critical when selecting an appropriate technique for bulbar urethral reconstruction. Excision and primary anastomosis are superior to grafts in the proximal bulb. Grafts are often unnecessary for reconstructing proximal bulbar strictures 5 cm or less.
我们比较了近端和远端球部尿道狭窄的重建经验，以评估在每个部位切除和一期吻合与移植物手术的作用。
我们回顾了一位外科医生在两年期间进行的所有尿道成形术。分析的数据包括患者病史和人口统计学、手术细节、狭窄长度和部位以及临床结果。近端球部尿道定义为膜部尿道 5cm 以内的节段，远端球部定义为延伸至阴茎阴囊交界处的毗邻节段。排除涉及悬垂或后尿道的病例。
在 2007 年至 2009 年的 210 例尿道成形术中，112 例为球部狭窄，其中 72 例（64%）为近端球部狭窄。所有 72 例均采用切除和一期吻合治疗。中位狭窄长度为 2cm（范围 1 至 5cm），尽管 72 例狭窄中有 31 例（43%）为中等长度（2.5 至 5cm）。1 例（1.4%）复发。112 例中的 40 例（36%）远端球部狭窄主要采用替代尿道成形术治疗，其中 36 例（90%）采用切除和一期吻合术治疗，4 例（10%）采用切除和一期吻合术治疗。中位狭窄长度为 3.75cm（范围 1.5 至 20cm）。我们注意到 40 例中有 18 例（45%）为中等长度狭窄，11 例（28%）复发。在中等长度狭窄中，切除和一期吻合术的复发率明显低于移植物手术（33 例中有 1 例，3.0%，16 例中有 6 例，38%，p<0.05）。
在选择球部尿道重建的合适技术时，位置至关重要。在近端球部，切除和一期吻合优于移植物。对于 5cm 或更短的近端球部狭窄，移植物通常不是必需的。
