Hussein Mohamed M, Almogazy Hazem, Mamdouh Ahmed, Farag Fawzy, Rashed Elnesr, Gamal Wael, Rashed Ahmed, Zaki Mohamed, Salem Esam, Ryad Ahmed
Urology Department, Sohag Faculty of Medicine, Sohag University Hospital, Sohag University, Sohag, Egypt.
Int Urol Nephrol. 2016 Nov;48(11):1831-1835. doi: 10.1007/s11255-016-1366-0. Epub 2016 Jul 11.
To investigate the surgical outcomes of dorsal onlay urethroplasty (DOU) using buccal mucosa graft (BMG) or penile skin graft (PSG) and to assess the effect of stricture length in men with anterior urethral strictures.
A prospective cohort included men with anterior urethral strictures between 2008 and 2015. Patients underwent DOU using PSG or BMG. Patients had urethrography and uroflowmetry at 0, 3, 6, 12 months, and urethroscopy when needed. Student's t test, Mann-Whitney U tests, and Pearson's Chi-square test were used for analysis.
Sixty-nine patients (43 ± 14 year) were included, 31 received BMG, and 38 received PSG. Mean stricture length was 8 ± 3 cm, mean operative time was 145 ± 31 min, and mean follow-up was 56 ± 10 mo. Success rate was 87 % (90 % BMG vs. 84 % PSG, p = 0.4). Mean operative time was significantly shorter in PSG group (136 ± 29 min vs. 256 ± 58 min, p = 0.0005). Complications of grade I developed in 36 % (wound infection = 10 %, postvoiding dribbling = 18.8 %). Thirty of 69 patients (43 %) had strictures ≥8 cm, and 39 (57 %) had strictures <8 cm-success rate was equal for both subgroups (87 %). Mean blood loss, mean operative time, and incidence of postvoid dribbling were significantly lower in strictures <8 cm.
BMG and PSG have comparable success rates in treatment of long anterior urethral strictures. Operative time is significantly longer in BMG. Long-segment strictures are associated with longer operative time, more blood loss, and more occurrence of postvoid dribbling. However, the length of the stricture has no influence on the success rate and functional outcomes of DOU.
探讨采用颊黏膜移植物（BMG）或阴茎皮肤移植物（PSG）进行背侧镶嵌式尿道成形术（DOU）的手术效果，并评估前尿道狭窄男性患者狭窄长度的影响。
一项前瞻性队列研究纳入了2008年至2015年间患有前尿道狭窄的男性患者。患者接受了使用PSG或BMG的DOU手术。患者在术后0、3、6、12个月进行尿道造影和尿流率测定，并在需要时进行尿道镜检查。采用学生t检验、曼-惠特尼U检验和皮尔逊卡方检验进行分析。
共纳入69例患者（43±14岁），31例接受BMG，38例接受PSG。平均狭窄长度为8±3cm，平均手术时间为145±31分钟，平均随访时间为56±10个月。成功率为87%（BMG组为90%，PSG组为84%，p=0.4）。PSG组的平均手术时间明显更短（136±29分钟对256±58分钟，p=0.0005）。I级并发症发生率为36%（伤口感染=10%，排尿后滴沥=18.8%）。69例患者中有30例（4�%）狭窄长度≥8cm，39例（57%）狭窄长度<8cm——两个亚组的成功率相同（87%）。狭窄长度<8cm的患者平均失血量、平均手术时间和排尿后滴沥发生率明显更低。
BMG和PSG在治疗长段前尿道狭窄方面成功率相当。BMG的手术时间明显更长。长段狭窄与更长的手术时间、更多的失血量和更多的排尿后滴沥发生相关。然而，狭窄长度对DOU的成功率和功能结果没有影响。
