Centro Chirurgico Toscano, Arezzo, Italy.
Kulkarni Reconstructive Urology Center, Pune, India.
World J Urol. 2019 Nov;37(11):2473-2479. doi: 10.1007/s00345-019-02686-x. Epub 2019 Feb 23.
Repair of post-TURP sphincter urethral strictures represents challenging problem, due to the risk of urinary incontinence after the repair. We described a surgical technique we use to repair these strictures preserving urinary continence in patients with incompetent bladder neck.
An observational, retrospective, study was conducted to include patients with post-TURP urethral strictures in the area of distal sphincter. We included only patients with complete clinical data and follow-up who previously underwent TURP or HOLEP or TUIP, and subsequently developed proximal bulbar urethral strictures close to the membranous urethra and the related distal urethral sphincter. Patients were included, if they were fully continent after TURP or other procedures to treat BPH. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcome was post-urethroplasty urinary continence. Patients showing stricture recurrence or post-operative incontinence were classified as failure.
Overall, 69 patients were included in the study. Median patient's age was 67 years; median stricture length was 4 cm. Thirty-tree patients (47.8%) underwent previous urethrotomy. Median follow-up was 52 months. Out of 69 patients, 55 (79.7%) were classified as success and 14 (20.3%) as failure. Out of the whole cohort, thus, 11/69 (16%) have a risk of recurrent strictures and 3/69 (4.3%) have incontinence.
The use of modified ventral onlay graft urethroplasty, using particular non-aggressive steps, is a suitable surgical technique for repair of sphincter urethral stricture in patients who underwent BPH transurethral surgery, using different procedures (TURP, HOLEP, TUIP).
经尿道前列腺切除术（TURP）后发生的尿道括约肌狭窄是一个具有挑战性的问题，因为修复后可能会出现尿失禁。我们描述了一种我们用于修复这些狭窄的手术技术，该技术可以在膀胱颈部功能不全的患者中保持尿控。
进行了一项观察性、回顾性研究，纳入 TURP 后尿道狭窄部位位于远端括约肌的患者。我们仅纳入了具有完整临床数据和随访的患者，这些患者之前曾接受过 TURP 或经尿道前列腺切开术（HOLEP）或经尿道前列腺电切术（TUIP），随后在靠近膜部尿道和相关的远端尿道括约肌的部位发生了近端球部尿道狭窄。如果患者在接受 TURP 或其他治疗 BPH 的手术治疗后完全控尿，则将其纳入研究。研究的主要结局为治疗失败，定义为需要任何术后器械处理。次要结局为尿道成形术后尿控。如果患者出现狭窄复发或术后尿失禁，则归类为失败。
共有 69 例患者纳入研究。患者的中位年龄为 67 岁；狭窄长度的中位数为 4cm。33 例（47.8%）患者曾行尿道扩张术。中位随访时间为 52 个月。69 例患者中，55 例（79.7%）患者分类为成功，14 例（20.3%）为失败。因此，整个队列中有 11/69（16%）患者存在复发狭窄的风险，3/69（4.3%）患者存在尿失禁。
使用改良的腹侧覆盖移植尿道成形术，采用特定的非侵袭性步骤，是一种适用于经尿道前列腺切除术（TURP）不同手术（TURP、HOLEP、TUIP）治疗的 BPH 患者的修复尿道括约肌狭窄的手术技术。
