Powell Charles R, Daniels David
Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
Siouxland Urology (DD), Sioux City, Iowa.
Urol Pract. 2017 Jan;4(1):48-53. doi: 10.1016/j.urpr.2016.02.002. Epub 2016 Sep 21.
Female urethral stricture is rare and decreases quality of life. Buccal mucosa has become the most popular graft material for male urethroplasty but little is written about females. Rare case reports of buccal mucosa grafting in the female appear in the literature as an alternate method to more commonly performed vaginal flap urethroplasty (Blandy-style flap) or free vaginal mucosa graft urethroplasty. The hypothesis is that dorsal onlay buccal mucosa grafting will improve quality of life scores and provide acceptable recurrence-free rates.
We compiled a retrospective case series from 2009 to 2013 to identify female patients treated with dorsal onlay buccal urethroplasty via a suprameatal approach. All patients underwent pelvic exam as well as a supine stress test. Study end points included stricture recurrence verified by cystoscopy, uroflow, post-void residual urine, presence of urinary tract infection, pain, fistula formation, incontinence, and complications at the donor site and the vagina.
Six patients were identified. Mean followup was 18.6 months. No stress incontinence was noted preoperatively and none developed postoperatively. No fistulas were noted. Mean stricture length was 1.2 cm and mean graft length was 2.75 cm. Two stricture recurrences (33%) were noted, requiring dilation. Mean pain score went from 7.2 to 0 on a 10-point Likert scale (p = 0.004). The number of urinary tract infections per year decreased from 4.3 to 0.3 (p = 0.038). Maximum voided velocity increased from 5.6 to 13.1 ml per second (p = 0.003) and mean post-void residual urine decreased from 270 to 34 ml (p = 0.094). No urethral or vaginal complications were reported. Two patients reported donor site morbidity but no clitoral anesthesia or pain was reported.
Dorsal onlay buccal urethroplasty provided acceptable but not improved cure rates compared with the published failure rates of alternative methods. Patients experienced significant improvements in pain, urinary flow and quality of life. It can be safely considered instead of ventral onlay vaginal flap urethroplasty or serial dilation in females with stricture.
女性尿道狭窄较为罕见，会降低生活质量。颊黏膜已成为男性尿道成形术最常用的移植材料，但关于女性的相关报道较少。文献中罕见关于女性颊黏膜移植的病例报告，它是一种替代更常用的阴道皮瓣尿道成形术（布兰迪式皮瓣）或游离阴道黏膜移植尿道成形术的方法。我们的假设是，背侧覆盖颊黏膜移植术将改善生活质量评分，并提供可接受的无复发率。
我们收集了2009年至2013年的回顾性病例系列，以确定通过经尿道口上入路接受背侧覆盖颊黏膜尿道成形术治疗的女性患者。所有患者均接受盆腔检查以及仰卧位压力测试。研究终点包括通过膀胱镜检查、尿流率、排尿后残余尿量、尿路感染的存在、疼痛、瘘管形成、尿失禁以及供体部位和阴道的并发症来验证狭窄复发情况。
共确定6例患者。平均随访时间为18.6个月。术前未发现压力性尿失禁，术后也无患者出现。未发现瘘管。平均狭窄长度为1.2厘米，平均移植长度为2.75厘米。发现2例狭窄复发（33%），需要进行扩张。在10分制的李克特量表上，平均疼痛评分从7.2降至0（p = 0.004）。每年尿路感染的次数从4.3降至0.3（p = 0.038）。最大排尿速度从每秒5.6毫升增加到13.1毫升（p = 0.003），平均排尿后残余尿量从270毫升降至34毫升（p = 0.094）。未报告尿道或阴道并发症。2例患者报告了供体部位的并发症，但未报告阴蒂麻醉或疼痛情况。
与已公布的其他替代方法的失败率相比，背侧覆盖颊黏膜尿道成形术的治愈率可接受但未得到改善。患者在疼痛、尿流和生活质量方面有显著改善。对于患有狭窄的女性，可以安全地考虑采用这种方法替代腹侧覆盖阴道皮瓣尿道成形术或系列扩张术。
