Patel Jill S, Krzastek Sarah C, Roseman John T, Klausner Adam P, Anele Uzoma A
Division of Urology, Department of Surgery, Virginia Commonwealth University Medical Center Richmond, VA, USA.
Division of Urology, Department of Surgery, Central Virginia VA Health Care Systems Richmond, VA, USA.
Am J Clin Exp Urol. 2023 Feb 25;11(1):69-74. eCollection 2023.
Urosymphseal fistulas are a debilitating but treatable consequence of the combination of radiotherapy and endoscopic interventions in prostate cancer patients. Treatment includes fistula excision with a tissue flap to prevent communication of involved structures and provide structural and vascular support. We introduce a unique surgical approach of mobilizing and utilizing a corpus spongiosum flap in urosymphyseal fistula repair. A retrospective study identified two patients who underwent repair with a pedicled corpus spongiosum flap at our institution. The corpus spongiosum had adequate length and vascularization and limited the need for extra-pelvic muscle flaps, thus maintaining muscle integrity in the abdomen and thighs. Following extirpative surgery, both patients had durable fistula closure, decreased pelvic pain, and resolution of lower urinary tract symptoms and osteomyelitis. These cases highlight the potential of the corpus spongiosum to be a reasonable alternative interpositional flap in genitourinary reconstruction.
尿道耻骨联合瘘是前列腺癌患者放疗和内镜干预联合治疗后导致的一种使人衰弱但可治疗的后果。治疗方法包括瘘管切除并使用组织瓣，以防止受累结构相通，并提供结构和血管支持。我们介绍一种在尿道耻骨联合瘘修复中动员和利用海绵体瓣的独特手术方法。一项回顾性研究确定了两名在我们机构接受带蒂海绵体瓣修复的患者。海绵体长度足够且血运良好，减少了对盆腔外肌瓣的需求，从而保持了腹部和大腿肌肉的完整性。在根治性手术后，两名患者的瘘管均持久闭合，盆腔疼痛减轻，下尿路症状和骨髓炎得到缓解。这些病例突出了海绵体作为泌尿生殖系统重建中一种合理的替代插入瓣的潜力。
