Blaivas J G
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York.
J Urol. 1989 Mar;141(3):542-5. doi: 10.1016/s0022-5347(17)40887-1.
Vaginal flap urethral reconstruction was done in 10 women who sustained total or partial loss of the urethra, and extensive damage to the vesical neck and trigone due to operative complications. In all patients a neourethra was constructed by rolling a vaginal flap into a tube and covering the anastomosis with a labial pedicle fat pad graft and vaginal flap. Five patients underwent a concomitant pubovaginal sling procedure, 3 had a modified Pereyra operation and 1 had a modified Kelly plication. Postoperatively, 9 of the 10 patients had a satisfactory neourethra but 3 required a generous meatotomy to facilitate micturition. Two patients required temporary intermittent self-catheterization. Of the 10 patients 6 were completely continent after a single reconstruction, which included an anti-incontinence repair. Of the patients with postoperative incontinence 2 subsequently were cured with a pubovaginal sling and 1 had a vesicovaginal fistula that was successfully repaired transvaginally. These results support our contention that a vaginal flap urethral reconstruction combined with an appropriate anti-incontinence operation offers a viable and simple alternative to bladder flap urethral reconstruction.
对10名因手术并发症导致尿道完全或部分缺失、膀胱颈和三角区广泛受损的女性进行了阴道瓣尿道重建术。在所有患者中，通过将阴道瓣卷成管状并用带蒂阴唇脂肪垫移植和阴道瓣覆盖吻合口来构建新尿道。5例患者同时进行了耻骨后阴道吊带术，3例进行了改良佩雷拉手术，1例进行了改良凯利折叠术。术后，10例患者中有9例新尿道情况良好，但3例需要进行较大的尿道口切开术以促进排尿。2例患者需要临时间歇性自我导尿。10例患者中有6例在单次重建（包括抗尿失禁修复）后完全控尿。术后尿失禁的患者中，2例随后通过耻骨后阴道吊带术治愈，1例出现膀胱阴道瘘，经阴道成功修复。这些结果支持了我们的观点，即阴道瓣尿道重建术结合适当的抗尿失禁手术为膀胱瓣尿道重建术提供了一种可行且简单的替代方法。
