Clínica de Distúrbios do Trato Urinário, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil.
Int Braz J Urol. 2021 Jul-Aug;47(4):856-860. doi: 10.1590/S1677-5538.IBJU.2020.1131.
The management of complex urethral stenosis may involve different surgical techniques. As retraction of the graft may account for surgical failure, this risk increases in patients with more extensive stenosis requiring a graft of greater diameter. Although double grafts have already been used to maximize success in these cases, we propose a modified technique for urethroplasty with longitudinal urethral incision. The hypothesis was that this technique would increase the lumen by using only a urethral incision on the dorsal surface. Two patients presenting with recurrent urethral stenosis underwent urethroplasty using a double graft of oral mucosa that preserves the integrity of the spongy tissue and allows ventral inlay graft fixation using a midline relaxing incision in the portion of the urethra with stenosis. In both cases, the urethrocystoscopy and uroflowmetry performed after surgery showed a pervious and complacent urethra. After four and six months of follow-up, the postoperative outcomes were satisfactory for both patients. Further studies involving larger numbers of patients and long-term follow-up are required to evaluate the effectiveness of this method.
复杂尿道狭窄的处理可能涉及不同的手术技术。由于移植物回缩可能导致手术失败，因此对于需要更大直径移植物的更广泛狭窄的患者，这种风险会增加。尽管已经使用双移植物来最大限度地提高这些情况下的成功率，但我们提出了一种改良的尿道切开术治疗尿道狭窄的技术。假设该技术仅通过在背侧表面进行尿道切开即可增加管腔。两名患有复发性尿道狭窄的患者接受了使用口腔黏膜双移植物的尿道成形术，该手术保留了海绵体组织的完整性，并允许在狭窄段的尿道使用中线松弛切口进行腹侧镶嵌移植物固定。在两种情况下，手术后的尿道膀胱镜检查和尿流率检查均显示出通畅且满意的尿道。在四个和六个月的随访后，两名患者的术后结果均令人满意。需要进一步进行涉及更多患者和长期随访的研究，以评估该方法的有效性。
