Kotov S V, Belomitsev S V, Guspanov R I, Iritsyan M M, Surenkov D N, Semenov M K, Ugurchiev A M
Department of Urology and Andrology in N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow, Russia.
N.I. Pirogov City Clinical Hospital.
Urologiia. 2018 Dec(5):39-44.
In case of complex and long urethral stricture a use of augmentation technique is often limited by "critically" narrowing of urethral plate. In such cases, the augmentation anastomotic urethroplasty without division of the corpus spongiosum can be the method of choice, because it allows to perform simultaneous augmentation urethroplasty with maximal sparing of antegrade blood flow in corpus spongiosum.
In urologic clinic of N.I. Pirogov City Clinical Hospital No1 the analysis of 17 patients who were undergone to augmentation anastomotic urethroplasty without division of the corpus spongiosum (Kodama technique), performed by single surgeon from 2013 to 2017 yy was done. The meant stricture length was 3.75 cm (2-6). Penile, bulbar and panurethral stricture was found in 6 (35.3%), 7 (41.2%) and 4 (23.5%) cases, respectively.
Technique efficiency was 88.2% and in 2 patients (11.8%) a stricture recurrence developed. The mean maximum flow rate before and after surgery were 5.4 and 23.1 ml/s, respectively (p<0.05). The mean catheterization time was 14 (7-30) days. There were no patients with de novo urinary incontinence and erectile dysfunction.
The initial results of augmentation anastomotic urethroplasty without division of the corpus spongiosum showed high efficiency. To our opinion, the antegrade blood flow sparing makes it the method of choice in patients with long non-traumatic urethral stricture (without severe spongiofibrosis), good preoperative erectile function but isolated length of "critically" narrowing of the urethral lumen.
对于复杂且长段的尿道狭窄，扩大技术的应用常因尿道板的“严重”狭窄而受限。在此类情况下，不切开海绵体的扩大吻合性尿道成形术可能是首选方法，因为它能在最大程度保留海绵体顺行血流的同时进行扩大性尿道成形术。
在N.I. 皮罗戈夫市第一临床医院泌尿外科，对2013年至2017年由同一位外科医生实施的17例不切开海绵体的扩大吻合性尿道成形术（儿玉技术）患者进行了分析。平均狭窄长度为3.75厘米（2 - 6厘米）。阴茎部、球部和全尿道狭窄分别见于6例（35.3%）、7例（41.2%）和4例（23.5%）。
技术有效率为88.2%，2例患者（11.8%）出现狭窄复发。术前和术后的平均最大尿流率分别为5.4毫升/秒和23.1毫升/秒（p<0.05）。平均留置导尿时间为14天（7 - 30天）。无新发尿失禁和勃起功能障碍患者。
不切开海绵体的扩大吻合性尿道成形术的初步结果显示出高效性。我们认为，保留顺行血流使其成为长段非创伤性尿道狭窄（无严重海绵体纤维化）、术前勃起功能良好但尿道腔“严重”狭窄长度孤立的患者的首选方法。
