University of California, San Francisco, CA, USA.
BJU Int. 2012 May;109(9):1392-6. doi: 10.1111/j.1464-410X.2011.10483.x. Epub 2011 Aug 22.
Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Single-stage urethral segment replacement has historically poor outcomes and two-stage repairs are now more common. We present a novel approach to the single-stage repair with initial outcomes similar to two-stage repairs.
• To present our experience with repairing long-segment urethral strictures in a single-stage using a combined tissue-transfer technique.
• In all, 14 men underwent urethroplasty where a segment of urethra was completely replaced using a dorsal onlay buccal mucosa graft and a ventral onlay fasciocutaneous flap in a single stage. • Primary success was defined as an open urethra at >6 months follow-up with no need for additional surgical intervention. • Secondary success was defined as the need for a single postoperative endoscopic procedure before stricture stabilization. • Failure was the need for multiple endoscopic procedures, repeat urethroplasty, urinary diversion or intermittent dilatation.
• The mean (SD) stricture length was 9.75 (4.6) cm. The mean (SD) neourethral length was 5.4 (2.7) cm. Stricture location was penile/bulbar in 12 men, and bulbar alone in two. Primary success was achieved in nine of the 14 men at a median (range) follow-up of 2.5 (0.5-9.43) years. • The mean (SD) time to recurrence in the five initial failures was 340 (376) days. • Secondary success was achieved in two men after a single endoscopic procedure for an overall success in 11 of 14 men. • Patients that recurred had longer strictures (12.8 vs 8.7 cm, P= 0.04) than initial successes, but neourethral lengths were similar (6.2 vs 5.1 cm, P= 0.5). • In all, three of the 14 men failed, two of whom required a repeat urethroplasty.
• Our initial outcomes were favourable using the combined tissue-transfer technique for segmental urethral replacement with initial and secondary success rates similar to those reported for two-stage repairs. • This technique is not suitable for all patients as it requires healthy penile skin, but appears to be effective when a single-stage repair is desirable.
• 介绍我们使用联合组织转移技术一期修复长段尿道狭窄的经验。
• 14 名男性患者接受了尿道成形术，其中一段尿道完全被背侧黏膜移植瓣和腹侧筋膜皮瓣替代。• 主要成功定义为随访>6 个月时尿道开放，无需进一步手术干预。• 次要成功定义为需要一次术后内镜处理以稳定狭窄。• 失败定义为需要多次内镜处理、再次尿道成形术、尿流改道或间歇性扩张。
• 平均（SD）狭窄长度为 9.75（4.6）cm。平均（SD）新尿道长度为 5.4（2.7）cm。12 名男性患者的狭窄部位为阴茎/球部，2 名患者为球部。14 名男性中有 9 名在中位（范围）2.5（0.5-9.43）年的随访中达到主要成功。• 5 例初始失败中，复发时间的平均值（SD）为 340（376）天。• 2 名患者在单次内镜处理后获得了次要成功，14 名患者中有 11 名获得了总体成功。• 复发患者的狭窄长度更长（12.8 与 8.7cm，P=0.04），但新尿道长度相似（6.2 与 5.1cm，P=0.5）。• 14 名患者中有 3 名失败，其中 2 名需要再次尿道成形术。
• 使用联合组织转移技术一期修复尿道狭窄，初始和次要成功率与两期修复相似，我们的初步结果良好。• 该技术并不适合所有患者，因为它需要健康的阴茎皮肤，但当需要一期修复时，该技术似乎是有效的。
