Nhungo Charles John, Alexandre Amini Mitamo, Mushi Fransia Arda, Njiku Kimu Marko, Mwanga Ally Hamis, Mkony Charles A
Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Int J Surg Case Rep. 2024 May;118:109614. doi: 10.1016/j.ijscr.2024.109614. Epub 2024 Apr 3.
Urethral diverticulum (UD) is a saccular dilatation of the urethral wall, continuous with the true urethral lumen. It is categorized etiologically into congenital and acquired. The etiology of an acquired urethral diverticulum is thought to be secondary to trauma. The gold standard imaging modalities for diagnosis of UD are retrograde urethrogram (RGU) and micturating cystourethrogram (MCU). Management options include: nonoperative treatment, minimally invasive and open surgeries. Open surgeries comprise a primary anastomosis or, Substitution urethroplasty after UD excision, with the aim of excising the diverticulum, reestablishing the continuity of the urethra, and prevent urethrocutaneous fistula formation. We present a case of urethral diverticulum and bulbar urethral stricture successfully managed by surgical excision of UD and substitution urethroplasty.
We report a case of a 32-year-old man who had lower urinary tract symptoms following a traumatic urethral catheterization. Investigations done in a peripheral hospital revealed a short, bulbar urethral stricture and direct visual internal urethrotomy (DVIU) was done. Later he presented to us with urine retention, whereupon emergency suprapubic cystostomy was performed. After serial investigations, urethral diverticulectomy followed by single stage urethroplasty with ventral onlay buccal mucosa graft was done. He was followed for 12 months with good surgical outcome.
The development of Acquired UD has been attributed to several possible factors: pelvic fractures, urethral strictures, straddle injuries, long-term urethral catheterization, endoscopic direct injuries, lower urinary tract infections, and urethral surgeries. Depending on the presentation and investigation findings, management of UD is planned. Conservative management is possible for uncomplicated asymptomatic UD if the patient consents to follow-up. Surgery to remove the diverticulum and urethral reconstruction are required for complicated symptomatic UD; these procedures vary from patient to patient and are individualized.
It is important to base the choice to do surgery on the clinical presentation. Whether a concurrent urethral stricture is present is a critical factor in deciding on the best course of surgical treatment. In our case we opted to perform a substitution urethroplasty with ventral onlay buccal mucosa graft as our patient had a long bulbar urethral stricture proximal to the diverticulum.
尿道憩室（UD）是尿道壁的囊状扩张，与真正的尿道腔相连。其病因学上分为先天性和后天性。后天性尿道憩室的病因被认为继发于创伤。诊断UD的金标准影像学检查方法是逆行尿道造影（RGU）和排尿性膀胱尿道造影（MCU）。治疗选择包括：非手术治疗、微创和开放手术。开放手术包括一期吻合术或在切除UD后进行替代尿道成形术，目的是切除憩室、重建尿道连续性并防止尿道皮肤瘘形成。我们报告一例通过手术切除UD和替代尿道成形术成功治疗的尿道憩室合并球部尿道狭窄病例。
我们报告一例32岁男性，在创伤性尿道插管后出现下尿路症状。在外周医院进行的检查发现短段球部尿道狭窄，并进行了直视下内切开术（DVIU）。后来他因尿潴留前来我院就诊，随即进行了急诊耻骨上膀胱造瘘术。经过一系列检查后，进行了尿道憩室切除术，随后采用腹侧贴补颊黏膜移植进行一期尿道成形术。对他进行了12个月的随访，手术效果良好。
后天性UD的发生归因于多种可能因素：骨盆骨折、尿道狭窄、骑跨伤、长期尿道插管、内镜直接损伤、下尿路感染和尿道手术。根据临床表现和检查结果制定UD的治疗方案。如果患者同意随访，对于无并发症的无症状UD可进行保守治疗。对于复杂的有症状UD，需要进行手术切除憩室和尿道重建；这些手术因患者而异，是个体化的。
根据临床表现选择手术很重要。是否存在并发尿道狭窄是决定最佳手术治疗方案的关键因素。在我们的病例中，由于患者在憩室近端有长段球部尿道狭窄，我们选择采用腹侧贴补颊黏膜移植进行替代尿道成形术。
