Horuz Rahim, Göktaş Cemal, Çetinel Ali Cihangir, Akça Oktay, Selimoğlu Ahmet, Albayrak Selami
Department of Urology, Faculty of Medicine, Medipol University, İstanbul, Turkey.
Department of Urology, Kartal Training and Research Hospital, İstanbul, Turkey.
Turk J Urol. 2013 Dec;39(4):244-8. doi: 10.5152/tud.2013.061.
Posterior urethral strictures are difficult cases to treat for urologists. Anastomotic open urethroplasty is the major surgical treatment option, and various modifications/manipulations to the procedure have been recommended in the literature. We aimed to assess the advantages of performing antegrade endoscopy through the suprapubic cystostomy tract during perineal urethroplasty.
Thirty-six perineal urethroplasties combined with suprapubic cystoscopy were performed in 33 adult male patients between 2005 and 2011. Pre-and peri-operative records of the patients were evaluated, with a particular focus on suprapubic cystoscopy findings during urethroplasty.
The mean patient age was 41 years, and the mean lesion length was 2.6 cm (range 1-10 cm). Lesions were secondary to pelvic trauma in 21 patients, to a history of prostatic surgery in 8 patients, and to other miscellaneous causes in the 4 remaining patients. In 23 cases with normal bladder necks, the anastomosis was created under the guidance of antegrade cystoscopy with fluoroscopy. In 10 cases, stiff guide wires or paddles were used in addition to endoscopic light to identify the correct anastomosis site. In two procedures, fistula openings were identified during endoscopy, and fistula repair was performed along with anastomosis. In one case involving the longest lesion with involvement of the bladder neck, a combined perineal-transpubic urethroplasty was performed. The mean follow up duration was 19 (3-38) months. The overall success rate was 91%, and the re-operation rate was 9%.
Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perineal urethroplasty. This method provides the benefits of supplementary endoscopic findings and feasibility of certain maneuvers that facilitate debridement and anastomosis formation concurrent with perineal urethroplasty.
后尿道狭窄对泌尿外科医生来说是难治的病例。吻合性开放尿道成形术是主要的手术治疗选择，文献中已推荐了对该手术的各种改良/操作方法。我们旨在评估在会阴尿道成形术期间经耻骨上膀胱造瘘通道进行顺行性内镜检查的优势。
2005年至2011年期间，对33例成年男性患者实施了36例会阴尿道成形术并联合耻骨上膀胱镜检查。对患者的术前和围手术期记录进行了评估，特别关注尿道成形术期间的耻骨上膀胱镜检查结果。
患者的平均年龄为41岁，平均病变长度为2.6厘米（范围1 - 10厘米）。21例患者的病变继发于骨盆创伤，8例患者继发于前列腺手术史，其余4例患者病因不明。在23例膀胱颈正常的病例中，在顺行性膀胱镜检查及荧光透视引导下进行吻合。在10例病例中，除了内镜光源外，还使用了硬导丝或挡板来确定正确的吻合部位。在2例手术中，在内镜检查期间发现了瘘口，并在吻合的同时进行了瘘口修复。在1例病变最长且累及膀胱颈的病例中，实施了会阴 - 经耻骨尿道成形术联合手术。平均随访时间为19（3 - 38）个月。总体成功率为91%，再次手术率为9%。
耻骨上膀胱镜检查是会阴尿道成形术中一种易于实施的辅助手段。该方法具有补充内镜检查结果的益处，以及某些操作的可行性，这些操作有助于在会阴尿道成形术的同时进行清创和吻合口形成。
