Center for Reconstructive Urethral Surgery, Arezzo, Italy.
Int Braz J Urol. 2012 May-Jun;38(3):307-16; discussion 316. doi: 10.1590/s1677-55382012000300003.
We performed an overview of the surgical techniques suggested for the treatment of anterior urethral strictures using MEDLINE. In applying the MEDLINE search, we used the ″MeSH″ (Medical Subject Heading) and "free text" protocols. The MeSH search was conducted by combining the following terms: "urethral stricture", "flap", "graft", "oral mucosa", "urethroplasty", "urethrotomy" and "failed hypospadias". Multiple "free text" searches were performed individually applying the following terms through all fields of the records: "reconstructive urethral surgery", "end-to-end anastomosis", "one-stage", "two stage". Descriptive statistics of the articles were provided. Meta-analyses were not employed. Seventy-eight articles were determined to be germane in this review. Six main topics were identified as controversial in anterior urethra surgery: the use of oral mucosa vs penile skin; the use of free grafts vs pedicled flaps in penile urethroplasty; the use of grafts vs anastomotic repair in bulbar urethral strictures; the use of dorsal vs ventral placement of the graft in bulbar urethroplasty; the use of definitive perineal urethrostomy vs one-stage repair in complex urethral strictures; the surgical options for patients with failed hypospadias repair. Different points of view are documented and presented in the literature by various authors from different countries. The aim of this clinical overview is to survey the main controversial issues in surgical reconstruction of the anterior urethra focusing on the use of flap or graft, substitute material, type of surgery and challenging situations, such as failed hypospadias or complex urethral stricture repair.
我们在 MEDLINE 上进行了手术技术综述，以治疗前尿道狭窄。在应用 MEDLINE 搜索时，我们使用了“MeSH”（医学主题词）和“自由文本”协议。MeSH 搜索是通过组合以下术语进行的：“urethral stricture”（尿道狭窄）、“flap”（皮瓣）、“graft”（移植物）、“oral mucosa”（口腔黏膜）、“urethroplasty”（尿道成形术）、“urethrotomy”（尿道切开术）和“failed hypospadias”（失败的尿道下裂）。通过记录的所有字段单独进行了多个“自由文本”搜索，应用了以下术语：“reconstructive urethral surgery”（重建性尿道手术）、“end-to-end anastomosis”（端端吻合术）、“one-stage”（一期）、“two stage”（二期）。提供了文章的描述性统计信息。未进行荟萃分析。在本综述中确定了 78 篇相关文章。在尿道前手术中确定了 6 个主要有争议的主题：口腔黏膜与阴茎皮的应用；在阴茎尿道成形术中，游离移植物与带蒂皮瓣的应用；在球部尿道狭窄中，移植物与吻合修复的应用；在球部尿道成形术中，背侧与腹侧放置移植物的应用；在复杂尿道狭窄中，确定性会阴尿道造口术与一期修复的应用；失败的尿道下裂修复患者的手术选择。不同的观点由来自不同国家的不同作者在文献中记录并呈现。本临床综述的目的是调查前尿道外科重建的主要争议问题，重点关注皮瓣或移植物、替代材料、手术类型和挑战性情况（如失败的尿道下裂或复杂尿道狭窄修复）的使用。
