Department of Urology, New York University Langone Medical Center , New York , New York.
Department of Urology, University of San Francisco-California , San Francisco , California.
J Urol. 2019 Jun;201(6):1164-1170. doi: 10.1097/JU.0000000000000087.
We report multi-institutional outcomes in patients who underwent urethroplasty with a rectal mucosa graft.
We used the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database to identify patients who underwent urethral reconstruction with transanal harvest of a rectal mucosa graft. We reviewed preoperative demographics, stricture etiology, previous management and patient outcomes.
We identified 13 patients from April 2013 to June 2017. Median age at surgery was 54 years. The stricture etiology was lichen sclerosus in 6 of 13 patients (46%), idiopathic in 2 (15%), hypospadias in 1 (7%), prior gender confirming surgery in 3 (23%) and rectourethral fistula after radiation for prostate cancer in 1 (7%). Prior procedures included failed urethroplasty with a buccal mucosa graft in 9 of 13 patients (69%), direct vision internal urethrotomy in 2 (15%) and none in 2 (15%). Median stricture length was 13 cm. Stricture location in the 9 cisgender patients was panurethral in 5 (56%), bulbopendulous in 2 (22%) and bulbar in 2 (22%). It was located at the junction of the fixed urethra extending into the neophallus in all 3 patients (100%) who underwent prior gender confirming surgery. Mean rectal mucosa graft length for urethroplasty was 10.6 cm (range 3 to 16). Repair types included dorsal or ventral onlay, or 2-stage repair. Stricture recurred at a median followup of 13.5 months in 2 of 13 patients (15%). Postoperative complications included glans dehiscence, urethrocutaneous fistula and compartment syndrome in 1 patient each (7%). No rectal or bowel related complications were reported.
Urethral reconstruction with a transanal harvested rectal mucosa graft is a safe technique when a buccal mucosa graft is unavailable or not indicated.
我们报告了在接受经肛门采集直肠黏膜移植物进行尿道成形术的患者中的多机构治疗结果。
我们使用 TURNS（创伤和泌尿科重建外科医生网络）数据库来确定接受经肛门采集直肠黏膜移植物进行尿道重建的患者。我们回顾了术前人口统计学资料、狭窄病因、既往治疗和患者结局。
我们在 2013 年 4 月至 2017 年 6 月期间共确定了 13 名患者。手术时的中位年龄为 54 岁。13 名患者中的 6 名（46%）狭窄病因是硬化性苔藓，2 名（15%）为特发性，1 名（7%）为尿道下裂，3 名（23%）为先前的性别确认手术，1 名（7%）为前列腺癌放疗后直肠尿道瘘。9 名患者先前的手术包括 13 名患者中的 9 名（69%）失败的颊黏膜移植物尿道成形术、2 名（15%）直接视觉内尿道切开术和 2 名（15%）无手术。中位狭窄长度为 13cm。9 名顺性别患者的狭窄部位在 5 名（56%）为全尿道、2 名（22%）为球-悬垂部和 2 名（22%）为球部。所有 3 名（100%）先前接受过性别确认手术的患者，其狭窄部位均位于固定尿道交界处延伸至新阴茎。用于尿道成形术的直肠黏膜移植物的平均长度为 10.6cm（范围 3 至 16cm）。修复类型包括背侧或腹侧覆盖或 2 期修复。13 名患者中有 2 名（15%）在中位随访 13.5 个月时出现狭窄复发。术后并发症包括 1 名患者的龟头裂开、尿道皮瘘和筋膜间室综合征各 1 例（7%）。无直肠或肠道相关并发症报告。
当颊黏膜移植物不可用或不适用时，经肛门采集直肠黏膜移植物进行尿道重建是一种安全的技术。
