De Laet Christophe, De Win Gunter
Department of Urology, Antwerp University Hospital, Antwerp, Belgium.
Department of Urology, Antwerp University Hospital, Antwerp, Belgium; University of Antwerp Faculty of Medicine and Health Sciences/ ASTARC, Antwerp, Belgium; Adolescent and Reconstructive Urology, University College London Hospitals, London, UK.
Turk J Urol. 2022 Jul;48(4):309-314. doi: 10.5152/tud.2022.22024.
To describe a step-by-step approach for glans preserving urethroplasty with a dorsal inlay graft used for distal urethral strictures. Description of the Technique: The reconstruction was performed through a keyhole incision in the urethra. In this way, we achieve maximal exposure by a minimal incision and saving of the glans. After incision of the diseased dorsal urethral mucosa through the keyhole and the meatus, a buccal mucosa graft pull-through resulting in a dorsal inlay is done. Patient(s) and Methods: We treated 10 patients in different clinical settings with success by using the newly described technique below. We highlight and illustrate 1 case of a 34-year-circumcised male. Antegrade urethrogram showed a distal penile and fossa navicularis stricture with a total estimated length of 3.5 cm.
In this specific case the glans sparing approach had a surgical duration of 115 minutes. After 3 weeks the urinary catheter was removed. At 12 months, the patient reported no remaining urinary tract symptoms. Examination showed a fully healed lesion and an adequate uroflowmetry with a Qmax of 24 mL/s coming from 4 mL/s pre-operatively. In our 10-patient case series, all treated patients had complete resolution of their complaints, significant improvement in flow rates and excellent cosmetic results without complications.
In selected cases, the described technique is feasible, safe, and effective with excellent functional outcomes and better cosmetic results especially due to the glans preservation.
描述一种使用背侧镶嵌移植物治疗远端尿道狭窄的保留龟头尿道成形术的分步方法。技术描述：重建通过尿道的锁孔切口进行。通过这种方式，我们通过最小的切口实现最大程度的暴露并保留龟头。通过锁孔和尿道口切开病变的背侧尿道黏膜后，进行颊黏膜移植物拉入以形成背侧镶嵌。患者及方法：我们使用以下新描述的技术成功治疗了10例处于不同临床情况的患者。我们重点介绍并举例说明1例34岁行包皮环切术的男性患者。顺行尿道造影显示阴茎远端和舟状窝狭窄，总估计长度为3.5厘米。
在这个特定病例中，保留龟头的手术方法手术时间为115分钟。3周后拔除导尿管。12个月时，患者报告无残留尿路症状。检查显示病变完全愈合，尿流率良好，最大尿流率从术前的4毫升/秒提高到24毫升/秒。在我们的10例患者病例系列中，所有接受治疗的患者症状均完全缓解，尿流率显著改善，美容效果极佳，且无并发症。
在选定的病例中，所描述的技术可行、安全且有效，具有出色的功能结果和更好的美容效果，特别是由于保留了龟头。
