Lv XiangGuo, Xu Yue-Min, Xie Hong, Feng Chao, Zhang Jiong
Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.
Urology. 2016 Jul;93:197-202. doi: 10.1016/j.urology.2016.02.051. Epub 2016 Mar 10.
To explore selection of the procedures in one-stage urethroplasty for treatment of coexisting urethral strictures in the anterior and posterior urethra.
Between 2008 and 2014, a total of 27 patients with existing strictures simultaneously at anterior urethra and posterior urethra were treated in our hospital. Two types of procedures were selected for treatment of the anterior urethral strictures. A penile skin flap and the lingual mucosa were used for augmented urethroplasty in 20 and 7 cases, respectively. Three types of procedures, namely, non-transecting end-to-end urethral anastomosis (n = 3), traditional end-to-end urethral anastomosis (n = 17), other grafts substitution urethroplasty, including pedicle scrotal skin urethroplasty (n = 2), and lingual mucosal graft urethroplasty (n = 5), were utilized in the treatment of posterior urethral strictures.
The patients were mean followed up 30 months with an overall success rate of 88.9%. The majority of the patients exhibited wide patent urethras on retrograde urethrography and the patients' urinary peak flow ranged from 14.2 to 37.9 ml/s. Complications developed in 3 patients (11.1%). Of the 17 patients who underwent traditional urethral end-to-end anastomosis, urethral strictures occurred in 2 patients at 4 and 6 months after the operation. These patients achieved a satisfactory voiding function after salvage pedicle scrotal skin urethroplasty. A urethral pseudodiverticulum was observed in another patient 9 months after pedicle penile flap urethroplasty; and after a salvage procedure, he regained excellent voiding function.
Synchronous anterior and posterior strictures can be successfully reconstructed with a combination of substitution and anastomotic urethroplasty techniques.
探讨一期尿道成形术治疗前后尿道并存狭窄的术式选择。
2008年至2014年，我院共治疗27例前后尿道同时存在狭窄的患者。治疗前尿道狭窄选用了两种术式。分别有20例和7例采用阴茎皮瓣和舌黏膜进行尿道扩大成形术。治疗后尿道狭窄采用了三种术式，即非横断端端尿道吻合术（n = 3）、传统端端尿道吻合术（n = 17）、其他移植物替代尿道成形术，包括带蒂阴囊皮瓣尿道成形术（n = 2）和舌黏膜移植尿道成形术（n = 5）。
患者平均随访30个月，总成功率为88.9%。大多数患者逆行尿道造影显示尿道通畅，尿流率峰值为14.2至37.9 ml/s。3例患者（11.1%）出现并发症。在17例行传统尿道端端吻合术的患者中，2例分别在术后4个月和6个月发生尿道狭窄。这些患者在挽救性带蒂阴囊皮瓣尿道成形术后排尿功能满意。1例患者在带蒂阴茎皮瓣尿道成形术后9个月出现尿道假性憩室；经过挽救性手术后，其排尿功能恢复良好。
采用替代和吻合尿道成形术技术相结合可成功重建前后尿道同步狭窄。
