Department of Urology, Sakarya Training and Research Hospital, Sakarya, Turkey.
Urology. 2011 Jun;77(6):1318-24. doi: 10.1016/j.urology.2011.01.017. Epub 2011 Apr 3.
To report our experience with urethroplasty in women with urethral stricture and discuss the therapeutic considerations and outcomes of various flap- and graft-based techniques.
A total of 17 patients with mid to distal urethral stricture (urethral caliber <14F, maximal urinary flow rate <12 mL/s, and detrusor pressure >20 cm H(2)O during voiding) underwent urethroplasty from 2004 to 2010. Of the 17 patients, 7 had undergone previous instrumentation and 10 were repaired primarily. The preoperative workup included American Urological Association symptom score assessment, uroflowmetry, voiding cystourethrography, and urethrocystoscopy. Of the 17 patients, 10 received anterior vaginal wall mucosa inlay urethroplasty. Proximally, the dilated urethral mucosa was used in 1 patient. A Martius flap reinforced ventral buccal mucosa graft (BMG) onlay urethroplasty was used in 2 patients with previous synthetic midurethral slings. Two patients with an atrophic vagina received a dorsal BMG onlay. A circular BMG reconstruction was used in 2 patients with severe distal urethral stricture. The preoperative findings were compared with the postoperative data at the last follow-up using the Wilcoxon sign test.
With a median follow-up of 24 months (range 6-78), an objective and subjective cure was achieved in 17 (100%) and 15 (88%) patients, respectively. At the last follow-up, the mean maximal urinary flow rate increased from 10.8 ± 3.2 mL/s preoperatively to 28.9 ± 7.4 mL/s (P = .001), and the mean postvoid residual urine volume had decreased from 120 ± 30 mL preoperatively to 30 ± 12 mL (P = .001). The mean American Urological Association score had decreased from 27.1 ± 3.9 preoperatively to 7.1 ± 3.5 postoperatively (P < .0001).
Primary urethroplasty can be considered a first-line option for treatment of female urethral strictures. Local mucosal flaps will cure the problem in most situations. BMG offers an excellent alternative when viable local tissue is absent.
报告我们在女性尿道狭窄患者中进行尿道成形术的经验，并讨论各种皮瓣和移植物技术的治疗考虑因素和结果。
2004 年至 2010 年间，17 例中段至远端尿道狭窄（尿道口径<14F，最大尿流率<12mL/s，排尿时逼尿肌压>20cmH2O）的患者接受了尿道成形术。17 例患者中，7 例有既往器械检查史，10 例为初次修复。术前检查包括美国泌尿外科学会症状评分评估、尿流率、排尿性膀胱尿道造影和尿道膀胱镜检查。17 例患者中，10 例行前阴道壁黏膜镶嵌尿道成形术。1 例患者采用近端扩张尿道黏膜。2 例曾行合成型中尿道吊带术的患者采用 Martius 皮瓣加强腹侧颊黏膜移植物（BMG）覆盖尿道成形术。2 例阴道萎缩的患者行背侧 BMG 覆盖。2 例严重远端尿道狭窄的患者行环形 BMG 重建。采用 Wilcoxon 符号检验比较术前和末次随访时的术后数据。
中位随访 24 个月（范围 6-78 个月），17 例（100%）和 15 例（88%）患者分别获得客观和主观治愈。末次随访时，最大尿流率从术前的 10.8±3.2mL/s 增加到 28.9±7.4mL/s（P=.001），残余尿量从术前的 120±30mL 减少到 30±12mL（P=.001）。美国泌尿外科学会评分从术前的 27.1±3.9 降至术后的 7.1±3.5（P<.0001）。
原发性尿道成形术可作为女性尿道狭窄的首选治疗方法。在大多数情况下，局部黏膜皮瓣可治愈该问题。当不存在可行的局部组织时，BMG 是一种极好的替代方法。
Zotero 插件