La Fe University Hospital, Valencia.
La Fe University Hospital, Valencia.
Urology. 2021 Jun;152:197-198. doi: 10.1016/j.urology.2021.02.003. Epub 2021 Feb 10.
Nowadays, short bulbar strictures refractory to one endoscopic treatment attempt could be managed with non-transecting urethroplasty technique as a first option. Jordan et al and Bugeja et al described a dorsal approach, sparing vessels, and spongiosum in the hope of a decrease of surgical side effects.
To describe the step-by-step technique of the ventral approach for the non-transecting bulbar urethroplasty in distal and mid short bulbar strictures.
We performed a prospective observational study of a cohort of patients who underwent a ventral non-transecting bulbar urethroplasty for short mid or distal bulbar strictures from January 2016 to December 2018. We included 10 patients.
A ventral midline urethrotomy is made and extended to assure a good caliber lumen both distally and proximally (20 Fr). The mucosal scar tissue is marked and a mucosectomy is performed, preserving the spongiosum.We bring the distal and proximal edges of healthy mucosa together without tension with a 5/0 absorbable monofilament. Ventral stricturotomy is closed over a 20F catheter, in a Heinike-Mikulics fashion, with 5/0 absorbable monofilament for the mucosal anastomosis and a 4/0 absorbable monofilament for the spongioplasty.
Mean age was 56,50 years (+/-17,27) and mean stricture length was 1,06cm (+/-1,82). The majority of strictures (90%) were located in the mid bulb. After a mean follow up of 27,25 months (+/-12,12), 9 patients remain recurrence-free (87,5%). A significant mean increase in Qmax was observed (12+/-4,53 ml/s, p=0,04). Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROMS), items (Questions 1-6) related to urinate symptoms also showed a significant improvement(p=0,03). We didn't find any significant decrease in erectile function with this technique.
The ventral approach for mid and distal short bulbar strictures is a feasible and reproducible technique with a significant increase in Qmax and improvement in USS-PROMS. Preliminary results show no decrease in erectile function.
如今，对于首次内镜治疗失败的短段球部狭窄，可以选择非横断性尿道成形术作为首选治疗方法。Jordan 等人和 Bugeja 等人描述了一种背侧入路，保留血管和海绵体，以期减少手术的副作用。
描述一种用于治疗短段球部中下段狭窄的非横断性球部尿道成形术的腹侧入路的分步技术。
我们对 2016 年 1 月至 2018 年 12 月期间接受腹侧非横断性球部尿道成形术治疗短段球部中下段狭窄的患者进行了一项前瞻性观察研究。我们纳入了 10 例患者。
沿腹中线作尿道切开，并向远、近端延伸，以确保腔道有良好的口径（20Fr）。标记黏膜瘢痕组织，行黏膜切除术，保留海绵体。无张力地将远端和近端健康黏膜边缘一起合拢，用 5/0 可吸收单丝缝合。用 5/0 可吸收单丝行黏膜吻合，用 4/0 可吸收单丝行海绵体成形术，以 Heinike-Mikulics 方式关闭腹侧狭窄。
平均年龄为 56.50 岁（±17.27），平均狭窄长度为 1.06cm（±1.82）。90%的狭窄（90%）位于球部中段。平均随访 27.25 个月（±12.12）后，9 例患者（87.5%）无复发。最大尿流率（Qmax）显著增加（12±4.53ml/s，p=0.04）。尿道狭窄手术患者报告结局测量（USS-PROMS）中与排尿症状相关的项目（问题 1-6）也有显著改善（p=0.03）。我们没有发现这种技术会显著降低勃起功能。
对于中下段短段球部狭窄，腹侧入路是一种可行且可重复的技术，可显著提高 Qmax，并改善 USS-PROMS。初步结果显示，勃起功能无明显下降。
