后颊黏膜移植尿道成形术治疗根治性前列腺切除术后的尿道吻合口狭窄。

Dorsal Buccal Mucosal Graft Urethroplasty for Vesico-Urethral Anastomotic Stricture Postradical Prostatectomy.

机构信息

Urology Department, Northern Ontario School of Medicine, Thunder bay, Ontario, Canada.

出版信息

Urology. 2019 Aug;130:210. doi: 10.1016/j.urology.2019.04.022. Epub 2019 Apr 27.

DOI:10.1016/j.urology.2019.04.022

PMID:31039367

Abstract

OBJECTIVE

To introduce a new technique using dorsal buccal mucosal graft (BMG) for the repair of refractory vesico-urethral anastomotic stricture/stenosis (VUAS) postopen radical prostatectomy.

METHODS

Patients demographics, preoperative continence status, number of dilations, and urine flow preoperatively and postoperatively were collected. Using perineal incision, after dissection of bulbar urethra, a dorsal dissection carried out underneath the pubic bone. The urethra was opened dorsally till the bladder neck. BMG was harvested and sutured to the bladder neck at 11, 12, and 1 o'clock. Interrupted dorsal quilting of the graft was done using 4-0 Vicryl through the periosteum over the pubic bone. The graft was sutured to the urethra using 4-0 Vicryl in a continuous fashion. Patients were discharged home in 2 days. Trial of void and retrograde urethrogram were done after 3 weeks. Flow and postvoid residual were done at 3 months.

RESULTS

A total of 4 patients between July and August 2018. The mean age was 67 (59-72). Three out of 4 patients (75%) had received adjuvant radiotherapy. The mean number of preop endoscopic procedures including dilations and incisions was 7 (4-10). The mean stricture length was 2.5 cm (2-3). All patients were incontinent preoperatively with mean preop flow of 5 mL/s (3-7 mL/s). Mean operative time and blood loss were 177 minutes and 250 mL, respectively. Mean postoperative urine flow at 3 months was 20 mL/s (17-23 mL/s). All patients were incontinent postoperatively. Success rate was 100% at 3 months.

CONCLUSION

BMG urethroplasty in vesico-urethral anastomotic stricture/stenosis is a new technique that can provide a safe perineal approach while eliminating the potential risk of rectal injury, and urethral atrophy from extensive urethral mobilization. It can also decrease the need for laparotomy or the need to perform a combined abdominal-perineal approach. Long-term follow-up is warranted with a larger cohort of patients.

摘要

目的

介绍一种使用背侧颊黏膜移植物（BMG）修复开放性根治性前列腺切除术后难治性膀胱-尿道吻合口狭窄/梗阻（VUAS）的新技术。

方法

收集患者的人口统计学资料、术前控尿状态、术前和术后扩张次数以及尿流率。采用会阴切口，在球部尿道解剖后，在耻骨下方进行背侧解剖。在膀胱颈背侧切开，直至膀胱颈。采集 BMG 并在 11、12 和 1 点钟缝合至膀胱颈。使用 4-0 Vicryl 通过耻骨骨膜进行移植物背侧间断缝合。使用 4-0 Vicryl 将移植物连续缝合至尿道。患者术后 2 天出院。术后 3 周进行排尿试验和逆行尿道造影，术后 3 个月进行流量和残余尿检查。

结果

2018 年 7 月至 8 月共 4 例患者。平均年龄为 67 岁（59-72 岁）。4 例中有 3 例（75%）接受了辅助放疗。术前内镜检查包括扩张和切开的平均次数为 7 次（4-10 次）。平均狭窄长度为 2.5cm（2-3cm）。所有患者术前均有尿失禁，平均术前流量为 5mL/s（3-7mL/s）。平均手术时间和出血量分别为 177 分钟和 250mL。术后 3 个月平均尿流率为 20mL/s（17-23mL/s）。所有患者术后均有尿失禁。3 个月时成功率为 100%。