Angulo J C, Mateo E, Lista F, Andrés G
Servicio de Urología, Hospital Universitario de Getafe, Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Servicio Madrileño de Salud, Departamento de Morfología, Estructura y Función, Facultad de Medicina, Universidad Europea de Madrid, España.
Actas Urol Esp. 2011 Apr;35(4):240-5. doi: 10.1016/j.acuro.2011.01.001. Epub 2011 Feb 26.
Female urethral stricture secondary to erosión by suburethral sling is an unfrequent problem of difficult solution. Ventral vaginal rotation flaps or buccal mucosa dorsal grafts are not useful because this type of stricture is very proximal (close to the bladder neck) and the vagina is thinned. We present our experience to manage this problem using excision of disease urethral tract, associated to bladder mucosa flap and vaginal sling using transverse vaginal flap to repair the weakened vaginal wall.
Three females with urethral stricture secondary to urethral erosion of their sling were treated with a technique of combined urethroplasty with bladder flap and vaginal reinforcement with pediculated vaginal flap transferred in a mini-sling fashion. Two of the patients suffered chronic urinary retention and preoperative placement of urethral catheter was not possible. The patients were evaluated 12, 36 and 55 months after surgery, respectively.
Surgery was performed without complications. Results were satisfactory in all the patients, reaching good micturition postoperative caliber and being without incontinence at follow-up.
Patients with suburethral erosion by a synthetic sling and secondary severe urethral stricture need total extirpation of the mesh and complete reconstruction of the urethro-vaginal septum. Tension-free urethral suture and use of vaginal sling with the technique here described are two useful technical tips for this problem.
尿道下吊带侵蚀继发的女性尿道狭窄是一个难以解决的罕见问题。阴道腹侧旋转皮瓣或颊黏膜背侧移植均无用，因为这种类型的狭窄非常靠近近端（接近膀胱颈）且阴道变薄。我们介绍了使用切除病变尿道、联合膀胱黏膜瓣和阴道吊带（采用横向阴道皮瓣修复薄弱的阴道壁）来处理这个问题的经验。
三名因吊带尿道侵蚀继发尿道狭窄的女性采用了联合尿道成形术（带膀胱瓣）和阴道加固术（采用带蒂阴道皮瓣以迷你吊带方式转移）进行治疗。其中两名患者患有慢性尿潴留，术前无法放置尿道导管。分别在术后12、36和55个月对患者进行评估。
手术无并发症。所有患者的结果均令人满意，术后排尿口径良好，随访时无尿失禁。
合成吊带尿道侵蚀继发严重尿道狭窄的患者需要完全切除网片并完全重建尿道阴道隔。无张力尿道缝合以及使用本文所述技术的阴道吊带是解决此问题的两个有用技术要点。
