Sterling Joshua, Schardein Jessica, Joshi Pankaj M, Kulkarni Sanjay B, Nikolavsky Dmitriy
SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
Kulkarni Reconstructive Urology Center, Pune, Maharahstra, India.
Int Urol Nephrol. 2022 May;54(5):1047-1052. doi: 10.1007/s11255-022-03154-z. Epub 2022 Mar 5.
Patients with devastated bulbar urethras have limited surgical options to restore normal upright voiding. We investigated the long-term feasibility of using two independently vascularized urethral hemi-plates lined with buccal mucosal graft (BMG) to treat these patients.
A multi-institutional retrospective review was conducted for patients that underwent this staged repair. In stage-1, the affected urethra is dissected and removed or prepared for a dorsal inlay augmentation. Two BMG segments are harvested; one graft is quilted on corpora cavernosa and urethra, creating an augmented perineal urethrostomy, and the other is quilted on the exposed distal gracilis muscle. Stage-2 utilizes the gracilis-BMG composite to recreate ventral bulbar urethra. The primary outcome measure was stricture recurrence. Secondary outcome measures included patient-reported outcome measures (PROMs).
Five patients with mean age of 50 years (45-56) underwent staged repairs at two institutions between 7/2014 and 4/2016. All patients presented with suprapubic tubes and underwent at least one prior failed repair (1-9). Mean stricture length was 7.2 cm (5-9). Mean time between stage-1 and stage-2 repairs was 6.2 weeks (1-10). At a mean follow-up of 61 months (39-87), there were no recurrences. The mean uroflow was 20 cc/s (9-42) with a mean PVR of 59 cc (0-157). Four patients completed post-operative surveys; all reported at least a moderate improvement in their condition on Global Response Assessment (GRA), and a mean IPSS of 7.3 (0-26).
Our bi-institutional case series demonstrates that this technique is a feasible option for devastated urethras with long-term durability.
球部尿道严重受损的患者恢复正常直立排尿的手术选择有限。我们研究了使用两片独立血管化的尿道半板内衬颊黏膜移植物（BMG）治疗这些患者的长期可行性。
对接受该分期修复的患者进行多机构回顾性研究。在第一阶段，解剖并切除或准备好受影响的尿道以进行背侧镶嵌式增大手术。采集两片BMG；一片移植物缝在海绵体和尿道上，形成扩大的会阴尿道造口术，另一片缝在暴露的股薄肌远端。第二阶段利用股薄肌 - BMG复合体重建球部尿道腹侧。主要结局指标是狭窄复发。次要结局指标包括患者报告结局指标（PROMs）。
2014年7月至2016年4月期间，两家机构对5名平均年龄为50岁（45 - 56岁）的患者进行了分期修复。所有患者均留置耻骨上导尿管，且之前至少有一次修复失败（1 - 9次）。平均狭窄长度为7.2厘米（5 - 9厘米）。第一阶段和第二阶段修复之间的平均时间为6.2周（1 - 10周）。平均随访61个月（39 - 87个月），无复发。平均尿流率为20毫升/秒（9 - 42毫升/秒），平均残余尿量为59毫升（0 - 157毫升）。4名患者完成了术后调查；所有患者在整体反应评估（GRA）中均报告病情至少有中度改善，平均国际前列腺症状评分（IPSS）为7.3（0 - 26）。
我们的双机构病例系列表明，该技术对于严重受损的尿道是一种具有长期耐久性的可行选择。
