Nakamura Masaki, Hakozaki Yuji, Iwata Shohei, Sato Yusuke, Makino Katsuhiro, Kawai Taketo, Yamada Yuta, Yamada Daisuke, Suzuki Motofumi, Omatsu Jun, Abe Masanobu, Hoshi Kazuto, Kume Haruki, Igawa Yasuhiko
Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Dermatology, The Graduate school of Medicine, The University of Tokyo, Tokyo, Japan.
J Med Case Rep. 2021 Mar 28;15(1):136. doi: 10.1186/s13256-021-02729-1.
Vulvar Paget's disease (VPD) is a rare malignant disorder originating in the external genitalia. It occasionally invades into urethral or vaginal mucosa of female, making surgical treatment more complicating. In case of urethral invasion of Paget's cells, systematic mapping biopsy of urethral mucosa is the standard of care to determine the range of surgical resection. Resection of urethral mucosa and simple skin grafting often result in urethral stricture after surgery, which severely deteriorates patient's quality of life.
We applied a new technique of advancement urethral meatoplasty using buccal mucosa, in two Japanese cases of VPD with urethral invasion. After broad resection of vulvar skin together with the urethral mucosa, buccal mucosa was implanted between advanced urethral mucosa and skin graft. In both cases, we could prevent urethral stricture one year and two years after surgery, respectively.
This technique prevented urethral stricture after surgery and could be a useful technique as part of urethroplasty for VPD.
外阴佩吉特病（VPD）是一种起源于外生殖器的罕见恶性疾病。它偶尔会侵犯女性的尿道或阴道黏膜，使手术治疗更加复杂。如果佩吉特细胞侵犯尿道，对尿道黏膜进行系统性定位活检是确定手术切除范围的标准治疗方法。切除尿道黏膜并单纯植皮术后常导致尿道狭窄，严重影响患者生活质量。
我们对两例日本VPD尿道侵犯患者应用了一种新的颊黏膜推进尿道成形术技术。在外阴皮肤与尿道黏膜广泛切除后，将颊黏膜植入推进的尿道黏膜与植皮之间。在这两例病例中，我们分别在术后一年和两年预防了尿道狭窄。
该技术可预防术后尿道狭窄，作为VPD尿道成形术的一部分可能是一种有用的技术。
