Emami Maryam, Shadpour Pejman, Kamali Koosha, Narimani Nima, Hosseini Jalil
Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
Hasheminejad Kidney Center (HKC), Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
Asian J Urol. 2023 Jan;10(1):33-38. doi: 10.1016/j.ajur.2022.04.002. Epub 2022 Apr 11.
To describe the outcome of female anterior wall (pubic side) onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.
From January 2016 to April 2018, 17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study. The diagnosis of urethral stricture was confirmed based on a combination of patients' symptoms, post-void residual urine, video-urodynamics, and cystoscopy. Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection. Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score, post-void residual urine, and maximum flow rate.
Despite the previously failed minimally invasive procedures, urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes (success rate=94%). The mean±standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up (25.82±3.97 to 10.88±5.57); so did postvoid residual urine (71.12±74.98 mL to 15.00±28.30 mL), and maximum flow rate (7.88±1.72 mL/s to 25.82±5.59 mL/s) with all statistically significant (<0.05).
The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands. An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate. A laterally extended incision may improve visualization and better graft placement by providing wider working space. The results should be evaluated in the future studies with larger sample size.
描述在先前微创技术失败的患者中，采用侧向扩展手术分离法进行颊黏膜移植的女性前壁（耻骨侧）嵌体尿道成形术的结果。
2016年1月至2018年4月，17例先前微创治疗失败且有症状的患者纳入本研究。根据患者症状、排尿后残余尿量、影像尿动力学和膀胱镜检查结果综合确诊尿道狭窄。采用改良的侧向扩展分离法进行下唇黏膜移植尿道成形术。术前及术后12个月对患者进行美国泌尿外科学会症状评分、排尿后残余尿量和最大尿流率评估。
尽管先前微创治疗失败，但下唇颊黏膜移植并侧向扩展分离的尿道成形术取得了良好效果（成功率=94%）。术后12个月随访时，美国泌尿外科学会症状评分的平均值±标准差较术前有所改善（从25.82±3.97降至10.88±5.57）；排尿后残余尿量也有改善（从71.12±74.98 mL降至15.00±28.30 mL），最大尿流率同样如此（从7.88±1.72 mL/s升至25.82±5.59 mL/s），差异均有统计学意义（<0.05）。
本研究表明，经验丰富的医生进行颊黏膜移植女性尿道成形术可取得很高的成功率。前路手术可能优于后路手术，因为其机械支撑力更强且囊袋形成率更低。侧向扩展切口可提供更广阔的操作空间，从而改善视野并更好地放置移植物。未来应开展更大样本量的研究对结果进行评估。
