Barbagli G, Lazzeri M
Urologia. 2007 Oct-Dec;74(4):233-41. doi: 10.5301/ru.2010.5890.
OBJECTIVES. To illustrate the history and the evolution over time of bulbar dorsal onlay urethroplasty, comparing outcomes when using buccal mucosa or skin grafts. MATERIALS AND METHODS. Ninety-four patients underwent bulbar urethral reconstruction using two dorsal onlay techniques, namely augmented anastomotic urethroplasty and dorsal onlay graft urethroplasty. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry and urethrography. Thirty-four patients underwent augmented anastomotic urethroplasty using penile skin (10 cases) or buccal mucosa (24 cases) grafts. Sixty patients underwent dorsal onlay graft urethroplasty using penile skin (38 cases) or buccal mucosa (22 cases) grafts. Forty-eight out of 94 patients received skin grafts and 46 buccal mucosal grafts. RESULTS. Sixty-four (68%) out of 94 cases were successful, whereas 30 (32%) failed. The 34 augmented anastomotic urethroplasties provided successful outcomes in 24 cases (70.6%), but poor outcomes in 10 (29.4%) cases. The 60 dorsal onlay graft urethroplasty proved to be successful in 42 cases (70%), failing in 18 (30%) cases. Twenty-eight (58.3%) out of 48 penile skin grafts were successful and 20 (41.7%) failed. Thirty-six (78.3%) out of 46 buccal mucosa grafts were successful and 10 (21.7%) failed. The 30 failed cases were then treated with internal urethrotomy in 14 cases (46.7%), perineal urethrostomy in 8 cases (26.7%), two-stage repair in 4 cases (13.3%), and one-stage repair in 4 cases (13.3%). CONCLUSIONS. The dorsal onlay technique used for bulbar urethral stricture repair has changed over time. In our experience, the buccal mucosa seems to be the best substitute graft material for bulbar urethroplasty using dorsal approach.
目的。阐述球部尿道背侧覆盖尿道成形术的历史及随时间的演变，比较使用颊黏膜或皮肤移植物时的手术效果。材料与方法。94例患者采用两种背侧覆盖技术进行球部尿道重建，即改良吻合尿道成形术和背侧覆盖移植物尿道成形术。术前评估包括临床病史、体格检查、尿培养、残余尿量测量、尿流率测定和尿道造影。34例患者采用改良吻合尿道成形术，使用阴茎皮肤（10例）或颊黏膜（24例）移植物。60例患者采用背侧覆盖移植物尿道成形术，使用阴茎皮肤（38例）或颊黏膜（22例）移植物。94例患者中，48例接受皮肤移植物，46例接受颊黏膜移植物。结果。94例患者中64例（68%）手术成功，30例（32%）失败。34例改良吻合尿道成形术中24例（74例（70.6%）手术成功，10例（29.4%）效果不佳。60例背侧覆盖移植物尿道成形术中42例（70%）成功，18例（30%）失败。48例阴茎皮肤移植物中28例（58.ꢀ3%）成功，20例（41.7%）失败。46例颊黏膜移植物中36例（78.3%）成功，10例（21.7%）失败。30例失败病例中，14例（46.7%）接受尿道内切开术治疗，8例（26.7%）接受会阴尿道造口术，4例（13.3%）接受两期修复，4例（13.3%）接受一期修复。结论。用于球部尿道狭窄修复的背侧覆盖技术随时间发生了变化。根据我们的经验，颊黏膜似乎是采用背侧入路进行球部尿道成形术的最佳替代移植物材料。
