Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy.
Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy.
Int Urol Nephrol. 2022 Dec;54(12):3171-3177. doi: 10.1007/s11255-022-03257-7. Epub 2022 Aug 13.
To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures.
Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire.
Median follow-up was 58 months (IQR 38-63) and mean stricture length was 1 cm (IQR 1-1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design.
In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications. We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.
报告我们在非横断背侧黏膜吻合加腹侧口腔移植物尿道成形术（NTAVOG）修复紧逼球部尿道狭窄方面的经验。
回顾性分析了 2012 年至 2019 年间 68 例紧逼球部狭窄患者行 NTAVOG 尿道成形术的数据。尿道从腹侧切开；切除背侧瘢痕化黏膜，保留海绵体；游离的黏膜边缘吻合以重建背侧尿道板；修复的尿道板通过腹侧口腔移植物增强，并覆盖海绵体。术后无需任何进一步处理即可正常排尿定义为成功尿道重建。采用经过验证的问卷评估性功能。
中位随访时间为 58 个月（IQR 38-63），平均狭窄长度为 1cm（IQR 1-1.5）。68 例中，56 例（82.4%）成功，12 例（17.6%）失败需要再次治疗。多变量分析显示，术前无任何因素与复发显著相关。术前 53 例有性生活的患者中，无 1 例报告术后勃起功能障碍，且所有患者均对性生活满意。主要局限性在于回顾性设计。
在紧逼球部狭窄的情况下，NTAVOG 尿道成形术通过保留海绵体并避免术后性并发症，提供足够的尿道增强。我们介绍了一系列接受非横断背侧吻合加腹侧口腔移植物尿道成形术治疗紧逼球部狭窄的患者。由于保留了海绵体，这种治疗方法似乎是安全的，且术后并发症有限。
