Fathi Atef, Mohamed Omar, Mahmoud Osama, Alsagheer Gamal A, Reyad Ahmed M, Hasan Ahmed M, Abdelrazek Mostafa, Saber-Khalaf Mohammed
Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Department of Urology, Sohag University Hospital, Sohag University, Sohag, Egypt.
Urologia. 2022 Feb;89(1):114-119. doi: 10.1177/03915603211003396. Epub 2021 Mar 25.
Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS).
A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed.
Thirty patients were identified. The median age (range) was 39 (25-61) years and a median (range) stricture length was 8 (6-14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12-24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2-11) ml/s preoperatively to 18 (range: 6-23) ml/s at the 6th month ( value < 0.001).
Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.
使用颊黏膜移植物进行替代尿道成形术可通过多种方法进行，包括腹侧覆盖移植、背侧覆盖移植或腹侧尿道切开加背侧嵌入移植。我们的研究旨在评估背外侧颊黏膜移植物治疗硬化性苔藓（LS）患者长段（>6 cm）前尿道狭窄的手术效果。
一项回顾性研究纳入了2013年1月至2019年4月因LS接受长段（>6 cm）前尿道狭窄修复的患者。所有患者在术后3、6、9和12个月进行随访，之后每年通过临床症状、尿流率测定以及排尿后残余尿量计算进行随访。有排尿症状或最大尿流率降低的患者需进行逆行尿道造影。需要后续尿道切开或尿道成形术的狭窄复发被视为手术失败。收集并分析成功率和手术并发症。
共纳入30例患者。中位年龄（范围）为39（25 - 61）岁，中位（范围）狭窄长度为8（6 - 14）cm。大多数术后并发症程度较轻。中位随访15（12 - 24）个月时的成功率为86.5%。中位最大尿流率从术前的6（2 - 11）ml/s显著增加至术后第6个月的18（范围：6 - 23）ml/s（P值<0.001）。
背外侧颊黏膜移植物尿道成形术治疗LS所致长段前尿道狭窄成功率高，包括狭窄复发在内的并发症风险低。
