Hofer Matthias D, Cooley Lauren Folgosa, Elmasri Ayman, Martins Francisco E
Urology San Antonio, San Antonio, TX 78258, USA.
Department of Urology, Northwestern University, Chicago, IL 60611, USA.
J Clin Med. 2021 Dec 16;10(24):5905. doi: 10.3390/jcm10245905.
Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered.
Thirty-four patients were included. The mean age was 56.7 years (range 15.7-84.9 years), the mean stricture length was 1.1 cm (0.5-1.5) and the mean follow-up was 42.5 months (28-61.3).
The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs.
The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.
根据病因、长度和位置，尿道远端狭窄的重建方法从简单的尿道口切开术到使用移植物或皮瓣不等。我们描述了一组当代尿道远端狭窄病例，并报告了一种称为远端一期尿道成形术的手术技术，该技术旨在解决大多数遇到的尿道远端狭窄问题。
纳入34例患者。平均年龄为56.7岁（范围15.7 - 84.9岁），平均狭窄长度为1.1厘米（0.5 - 1.5厘米），平均随访时间为42.5个月（28 - 61.3个月）。
绝大多数尿道远端狭窄（27/34，79.4%）采用我们的混合一期手术方法治疗，该方法将尿道远端重建与瘢痕组织切除相结合，无需使用移植物或皮瓣。平均狭窄长度为0.68厘米，平均手术时间为24.43分钟。少数患者（4/27，14.8%）报告有术后尿失禁。在34例患者中的7例（20.6%）使用了移植物或皮瓣，这些患者的狭窄长度和手术时间明显更长（分别为2.88厘米和154.8分钟，与混合一期手术方法相比，两者均P < 0.001）。我们注意到34例患者中有6例（17.6%）尿道远端狭窄复发，所有复发均通过移植物和皮瓣修复成功治疗。
绝大多数尿道远端狭窄适合采用远端一期尿道成形术，无需使用移植物和/或皮瓣，同时取得合理的治疗效果。这种有限的方法，至少在最初阶段，与较短的手术时间和导尿管留置时间相关，并避免了与移植物或皮瓣采集相关的并发症。尿失禁很少见，与其他治疗尿道远端狭窄的方法相当。
