Horiguchi Akio
Department of Urology, National Defense Medical College, Saitama, Japan.
Int J Urol. 2017 Jul;24(7):493-503. doi: 10.1111/iju.13356. Epub 2017 Jun 10.
Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics.
男性前尿道狭窄是海绵体上皮下组织的瘢痕形成，它会使尿道腔狭窄，导致尿流减少。其手术治疗是一个具有挑战性的问题，在过去几十年中发生了巨大变化。使用移植物或皮瓣进行开放手术修复，即替代尿道成形术，已成为不适用于切除和一期吻合的前尿道狭窄的金标准手术。从内侧脸颊采集的口腔黏膜（颊黏膜）是一种理想材料，最常用于替代尿道成形术，而从舌头下面采集的舌黏膜最近已成为一种效果相当的替代材料。在腹侧（腹侧覆盖）或背侧（背侧覆盖，巴尔巴利手术）覆盖口腔黏膜移植物已广泛用于球部尿道狭窄，成功率相当。在含有闭塞性或近乎闭塞性节段的球部尿道狭窄中，双侧背侧加腹侧覆盖（帕尔明泰里技术）或切除与一期吻合及覆盖增强相结合（增强吻合性尿道成形术）是首选手术。大多数阴茎尿道狭窄可通过背侧嵌入加腹侧矢状尿道切开术（阿索帕技术）或背外侧嵌入加单侧尿道剥离术（卡尔卡尼技术）在一期手术中修复；然而，分期尿道成形术仍然是复杂狭窄的首选手术，包括与生殖器硬化性苔藓或尿道下裂修复失败相关的狭窄。本文概述了使用口腔黏膜移植物的替代尿道成形术，并综述了当前的相关主题。
