Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, People's Republic of China.
J Urol. 2013 Jan;189(1):176-81. doi: 10.1016/j.juro.2012.09.005. Epub 2012 Nov 20.
We investigated a rationale for procedure selection to repair female urethral stricture associated with urethrovaginal fistula. We compared the outcomes of the 5 techniques used.
Between January 1999 and October 2011, 44 female patients with urethral stricture associated with urethrovaginal fistula were treated using a total of 5 techniques. The surgical techniques were labial pedicle flap urethroplasty in 24 patients, vulvar flap urethroplasty in 3, anterior vaginal flap urethroplasty in 11, end-to-end anastomosis in 4 and bladder flap urethroplasty in 2. Supplementary procedures were performed in some patients during urethroplasty, including bladder neck reshaping for incontinence in 5, intestinal-vaginal fistula repair in 3, colpoplasty for island vulvar skin flaps in 3, middle vaginal stricture vaginoplasty in 2 and enlargement of the vaginal introitus in 1.
Average postoperative followup was 42.3 months (range 6 to 140). Urethrovaginal fistula recurred in 2 patients because of infection, urethral stricture developed in 1 and stress incontinence appeared in 1. The other patients voided normally with an average maximum urine flow greater than 15 ml per second (range 16.7 to 46). The overall anatomical success rate was 93.18% (41 of 44 cases) and the functional success rate was 90.91% (40 of 44).
Surgical procedures for treating female urethral strictures with urethrovaginal fistulas should be based on fistula location, stricture length and vaginal anatomy. A transvaginal approach might be optimal if the vagina is wide and easily dilated. Pedicle labial flap urethroplasty was a reliable technique for complex strictures.
我们研究了一种选择修复女性尿道狭窄伴尿道阴道瘘的手术方法的原理。我们比较了使用的 5 种技术的结果。
1999 年 1 月至 2011 年 10 月，我们对 44 例尿道狭窄伴尿道阴道瘘的女性患者使用了 5 种技术进行治疗。手术技术包括 24 例阴唇皮瓣尿道成形术、3 例外阴瓣尿道成形术、11 例前阴道瓣尿道成形术、4 例端端吻合术和 2 例膀胱瓣尿道成形术。一些患者在尿道成形术中进行了补充手术，包括 5 例尿失禁膀胱颈成形术、3 例肠阴道瘘修补术、3 例岛状外阴皮瓣整形术、2 例中阴道狭窄阴道成形术和 1 例阴道入口扩大术。
平均术后随访 42.3 个月（6 至 140 个月）。2 例患者因感染导致尿道阴道瘘复发，1 例患者出现尿道狭窄，1 例患者出现压力性尿失禁。其他患者排尿正常，平均最大尿流率大于 15ml/s（16.7 至 46ml/s）。解剖学成功率为 93.18%（41/44 例），功能成功率为 90.91%（40/44 例）。
治疗女性尿道狭窄伴尿道阴道瘘的手术方法应根据瘘口位置、狭窄长度和阴道解剖结构而定。如果阴道宽敞且易于扩张，经阴道入路可能是最佳选择。带蒂阴唇皮瓣尿道成形术是治疗复杂狭窄的可靠技术。
