Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int Urogynecol J. 2021 Nov;32(11):2969-2973. doi: 10.1007/s00192-020-04486-z. Epub 2020 Aug 14.
The aims of this study were to describe a novel technique for transvaginal repair of large (> 4 cm) female urethral diverticulum (UD) using bipedicle double-opposing flaps of the periurethral fascia and to evaluate long-term follow-up.
The medical records of 29 women who underwent transvaginal excision of UD at our institution were reviewed retrospectively. Seventeen cases with UD > 4 cm were included in the study. Cystourethroscopy was performed at the beginning of the surgery, and in 60% of cases the orifice of the diverticulum was identified. An inverted-U incision was performed at the vaginal anterior wall. The periurethral fascia was incised longitudinal at the midline and parallel to the urethra. The diverticular sac was dissected and resected. The neck of the diverticulum was closed with 4/0 vicryl suture. The periurethral fascia was sutured using bipedicle double-opposing flaps with interrupted 3/0 vircyl suture. The vaginal mucosa was sutured with 2/0 vicryl continuous suture.
All 17 women with large UD were operated on using bipedicle double-opposing flaps of the periurethral fascia. Follow-up of 5 ± 2.4 years yielded no recurrence and no other late complications.
Using bipedicle double-opposing flaps of the periurethral fascia during transvaginal excision of large UD is safe and effective.
本研究旨在描述一种使用尿道周围筋膜双蒂对合皮瓣经阴道修复>4cm 女性尿道憩室（UD）的新方法，并评估长期随访结果。
回顾性分析我院 29 例行 UD 经阴道切除术的女性患者的病历资料，其中 17 例 UD>4cm 纳入研究。手术开始时行膀胱尿道镜检查，60%的病例可识别憩室的开口。在阴道前壁行倒 U 形切口，在中线纵向切开尿道周围筋膜，并与尿道平行。游离憩室囊，切除憩室。用 4/0 薇乔缝线缝合憩室颈部。用双蒂对合皮瓣间断缝合 3/0 薇乔缝线缝合尿道周围筋膜。阴道黏膜用 2/0 薇乔缝线连续缝合。
17 例大 UD 患者均采用尿道周围筋膜双蒂对合皮瓣进行手术。5±2.4 年的随访未见复发和其他晚期并发症。
经阴道切除大 UD 时使用尿道周围筋膜双蒂对合皮瓣是安全有效的。
