Shaw Nathan M, Mallahan Clare, Joshi Pankaj, Venkatesan Krishnan, Kulkarni Sanjay
Department of Urology, MedStar Georgetown, 110 Irving Street POB South 3rd Floor, Washington DC, 20010, USA.
Georgetown University School of Medicine, 3800 Reservoir Rd, Washington DC, USA.
Int Urol Nephrol. 2021 Jun;53(6):1127-1133. doi: 10.1007/s11255-020-02767-6. Epub 2021 Jan 2.
To evaluate the feasibility of ventral urethrotomy, dorsal inlay (Asopa) technique in management of urethrocutaneous fistula. The Asopa technique has been employed for management of urethral stricture repair but has not been described in adult penile urethrocutaneous fistula.
This is a retrospective review of IRB-approved databases of patients undergoing urethral reconstruction from two urologic reconstruction units. In this technique, the fistulous tract is circumscribed and excised, leaving a larger ventral urethral defect with healthy edges. The ventral-sagittal urethrotomy is extended, a dorsal urethrotomy made, and a graft inlaid dorsally to augment the urethral caliber prior to tension-free closure of the ventral urethrotomy.
From 2010 to 2019, ten patients underwent repair of urethrocutaneous fistula using the Asopa technique. Median patient age was 33.5 years (IQR 35.5). All fistulae involved penile urethra, eight had concomitant adjacent urethral stricture. Five patients failed prior hypospadias repair, three developed fistulae after surgery for penile urethral stricture, and two developed fistulae after extensive debridement (hidradenitis and Fournier's gangrene). Of these ten patients, oral mucosa graft was used in nine and preputial graft in one to augment the urethra. At median follow-up of 50.5 months (IQR 26.5), 80% (8/10) of patients demonstrated durably patent urethra, with no recurrence of fistula.
The Asopa technique is an established option for augmenting urethral caliber for urethral stricture disease. We demonstrate in our series that this technique can be applied to patients with urethrocutaneous fistulae.
评估腹侧尿道切开、背侧镶嵌（阿索帕）技术治疗尿道皮肤瘘的可行性。阿索帕技术已用于尿道狭窄修复，但尚未见其在成人阴茎尿道皮肤瘘治疗中的报道。
这是一项对来自两个泌尿外科重建单元的经机构审查委员会批准的尿道重建患者数据库的回顾性研究。在该技术中，将瘘管周围进行环切并切除，留下一个边缘健康的较大腹侧尿道缺损。延长腹侧矢状尿道切开，进行背侧尿道切开，并在无张力闭合腹侧尿道切开之前在背侧镶嵌移植物以扩大尿道管径。
2010年至2019年，10例患者采用阿索帕技术修复尿道皮肤瘘。患者年龄中位数为33.5岁（四分位间距35.5）。所有瘘均累及阴茎尿道，8例伴有相邻尿道狭窄。5例患者既往尿道下裂修复失败，3例在阴茎尿道狭窄手术后出现瘘，2例在广泛清创（汗腺炎和福尼尔坏疽）后出现瘘。这10例患者中，9例使用口腔黏膜移植物，1例使用包皮移植物来扩大尿道。中位随访50.5个月（四分位间距26.5），80%（8/10）的患者尿道持久通畅，无瘘复发。
阿索帕技术是扩大尿道管径治疗尿道狭窄疾病的一种既定选择。我们的系列研究表明，该技术可应用于尿道皮肤瘘患者。
