Palminteri Enzo, Berdondini Elisa, Di Pierro Giovanni Battista
Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy.
Department of Obstetrics and Gynecology Sciences and Urologic Sciences, 'La Sapienza' University, Rome, Italy.
Arab J Urol. 2013 Dec;11(4):350-4. doi: 10.1016/j.aju.2013.09.004. Epub 2013 Oct 31.
Several surgical techniques have been described for the treatment of bulbar urethral strictures, and the main goal of modern surgery is to reduce morbidity and obtain the best outcome with the fewest complications. Currently, the superiority of one surgical technique over another has not yet been clearly defined.
We analysed the historical background, advantages and disadvantages of several urethral approaches and graft placements, with the aim of focusing on the advantages of the ventral approach.
For short bulbar strictures (<2 cm) the traditionally advocated method is excision and end-to-end anastomosis, whilst for longer strictures, in the last decade, the patch graft urethroplasty has been used, with buccal mucosa advocated as the standard material of substitution. Our analysis showed that the approach (dorsal vs. ventral) to the bulbar urethral lumen and the location of the patch (dorsal vs. ventral) are contentious issues. Overall, surgeons tend to use techniques that are easy, quick and give excellent outcomes with few complications. The graft urethroplasty using the ventral approach fulfils these requirements.
已有多种手术技术用于治疗球部尿道狭窄，现代外科手术的主要目标是降低发病率，并以最少的并发症获得最佳疗效。目前，一种手术技术相对于另一种手术技术的优越性尚未明确界定。
我们分析了几种尿道入路和移植物植入的历史背景、优缺点，旨在关注腹侧入路的优势。
对于短球部狭窄（<2 cm），传统提倡的方法是切除并端端吻合，而对于较长的狭窄，在过去十年中，已采用补片移植尿道成形术，颊黏膜被提倡作为标准替代材料。我们的分析表明，进入球部尿道腔的入路（背侧与腹侧）以及补片的位置（背侧与腹侧）是有争议的问题。总体而言，外科医生倾向于使用简单、快速且并发症少、效果良好的技术。采用腹侧入路的移植尿道成形术满足这些要求。
