Department of Urology, Qena Faculty of medicine, South Valley University, Egypt.
Int Braz J Urol. 2018 Jan-Feb;44(1):163-171. doi: 10.1590/S1677-5538.IBJU.2017.0083.
To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm.
Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed.
Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow- up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant.
On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.
评估使用背侧黏膜移植（BM）或腹侧皮瓣（PS）进行前尿道 8cm 以上长段狭窄成形术的手术效果和失败预测因素。
2010 年 3 月至 2016 年 1 月，我院治疗 50 例前尿道 8cm 以上长段狭窄患者。评估手术效果和成功率。采用多因素分析分析失败的预测因素。当需要后续尿道扩张或尿道成形术时，认为发生了失败。
24 例患者行背侧 BM 移植，26 例患者行 PS 尿道成形术。两组患者的人口统计学特征、狭窄特征或随访期无显著差异。BM 组有 1 例患者在随访中失访。BM 组有 7 例（30.4%）患者出现狭窄复发，PS 组有 6 例（23.1%）患者（p 值=0.5）。两组患者的早期和晚期总并发症发生率无显著差异。单因素分析显示，早期并发症的发生和狭窄长度是失败的唯一预测因素，而多因素分析显示，早期并发症的发生是唯一显著的预测因素。
短期随访时，背侧 BM 移植和腹侧 PS 瓣尿道成形术的成功率相似。然而，BM 移植有减少手术时间的潜在优势，技术上也更容易。外科医生应避免早期局部并发症，因为它们代表更高的失败风险。
