Joshi Pankaj, Kaya Cevdet, Surana Sandesh, Desai Devang J, Orabi Hazem, Iyer Subramanian, Kulkarni Sanjay B
Kulkarni Reconstructive Urology Center, Pune, India.
Department of Urology, Marmara University School of Medicine, İstanbul, Turkey.
Turk J Urol. 2017 Dec;43(4):502-506. doi: 10.5152/tud.2017.72368. Epub 2017 Dec 1.
The use of methylene blue dye (MB) to highlight anatomical structures in urology has been well-established. Urethral stricture may extend about a centimeter beyond the abnormal area seen on urethrogram. Although the current literature suggests a tension-free and end- to- end anastomosis after excision of the strictured urethral segment with spongiofibrosis and surrounding corpus spongiosum in short bulbar strictures, some centers dealing with urethroplasty prefer anastomosis for short bulbar strictures while others prefer augmentation. With this study, use of MB for delineating stricture line and assessing spongiofibrosis in the diagnosis of urethral stricture was evaluated.
Five cc MB including 10 mg/mL is diluted with 10 cc saline. In the first scenario, MB is gently injected into urethra via the meatus before the urethroplasty procedure. Meanwhile, the extent of urethral segment stained by MB is noted. In the second scenario (MB spongiosography) in short bulbar stricture, insulin needles are inserted in spongiosa of the stricture site distally and proximally. MB is gently injected with distal needle. The two remaining needles are then observed. Presence of MB efflux in proximal needle implies deficiency of significant spongiofibrosis, so buccal augmentation is performed. Absence of efflux of MB implies significant spongiofibrosis and anastomotik site excised.
Four hundred and ninety-two consecutive cases prospectively evaluated between 2010 and 2014. Precise staining of stricture was successfully observed in 464 (94%) patients. Grossly normal appearing urothelium remained pink. Histopathology confirmed that the stained urethra had a stricture. Of the 22 short bulbar idiopathic strictures, in 18 (82%) MB was seen across the stricture and urethral transection was avoided. Anastomosis was performed in 4 (18%) cases where no MB went across the primary excision. There were no known allergic complications.
MB aids in delineating the urethral lumen and exact site of stricture that needs augmentation. MB Spongiography in short bulbar strictures could be used as a beneficial guide in relation to the type of urethral repair to be performed in terms of augmentation versus excision and anastomosis.
亚甲蓝染料（MB）在泌尿外科用于突出显示解剖结构已得到充分证实。尿道狭窄可能会延伸至尿道造影所见异常区域以外约1厘米处。尽管目前的文献表明，对于短段球部狭窄，在切除伴有海绵体纤维化的狭窄尿道段及周围海绵体后进行无张力端端吻合，但一些处理尿道成形术的中心在短段球部狭窄时更倾向于吻合，而其他中心则更倾向于扩大成形术。通过本研究，评估了MB在尿道狭窄诊断中用于勾勒狭窄线和评估海绵体纤维化的情况。
将5毫升含10毫克/毫升的MB用10毫升生理盐水稀释。在第一种情况下，在尿道成形术之前，通过尿道口将MB轻柔地注入尿道。同时，记录MB染色的尿道段范围。在第二种情况（MB海绵体造影）中，对于短段球部狭窄，在狭窄部位的海绵体远端和近端插入胰岛素针。通过远端针轻柔地注入MB。然后观察另外两根针。近端针出现MB外渗意味着海绵体纤维化不明显，因此进行颊黏膜扩大成形术。MB无外渗意味着海绵体纤维化明显，切除吻合部位。
2010年至2014年间对492例连续病例进行了前瞻性评估。在464例（94%）患者中成功观察到狭窄的精确染色。外观大致正常的尿路上皮仍呈粉红色。组织病理学证实染色的尿道存在狭窄。在22例短段球部特发性狭窄中，18例（82%）可见MB穿过狭窄，避免了尿道横断。在4例（18%）MB未穿过初次切除部位的病例中进行了吻合。没有已知的过敏并发症。
MB有助于勾勒尿道腔和需要扩大成形的狭窄的确切部位。短段球部狭窄的MB海绵体造影可作为在扩大成形术与切除吻合术方面进行尿道修复类型选择的有益指导。
