Abdel-Rassoul Mohammed, El Shorbagy Galal, Kotb Sameh, Alagha Ahmed, Zamel Samih, Rammah Ahmed M
Department of Urology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
Cent European J Urol. 2024;77(2):310-319. doi: 10.5173/ceju.2023.160. Epub 2024 Mar 15.
The aim of this study was to evaluate the outcomes of different urethroplasty procedures as well as two novel techniques, invented in our center, in management of urethral complications after total phallic reconstruction.
Different urethroplasty procedures were conducted according to the urethral pathology for 36 cis-male patients with urethral complications after total phallic reconstruction including meatoplasty, visual internal urethrotomy, staged Johanson urethroplasty utilizing either buccal mucosal graft or skin graft (Tiersche-Duplay principle), non-transecting urethroplasty (Hieneke-Miiklulicz principle), excision and primary anastomosis, as well as two novel techniques: urethral closure under a suprapubic tunnel and abdominal pedicled skin flap urethroplasty. Each patient was routinely evaluated one month after surgery and every 3 months for 12 months, with clinical evaluation, uroflowmetry and post-void residual urine.
With a total of 41 procedures for the 36 patients, 32 patients (88.8 %) could eventually void while standing. The success rate was highest for staged Johanson urethroplasty using split thickness skin graft, staged abdominal pedicled skin flap and excision and primary anastomosis, respectively, while it was lowest for visual internal urethrotomy (0% success) and non-transecting anastomotic urethroplasty (50% success). For staged versus one-stage procedures prospective analysis, 17 out of 26 one-stage procedures (65.4%) succeeded while 13 out of 15 staged procedures (86.6%) succeeded.
Urethral complications following phalloplasty require complex procedures demanding a high level of surgical expertise. Abdominal pedicled skin flap urethroplasty is a viable option for long and recalcitrant urethral strictures.
本研究旨在评估不同尿道成形术以及我们中心发明的两种新技术在阴茎全重建术后尿道并发症处理中的效果。
根据尿道病理情况，对36例阴茎全重建术后出现尿道并发症的顺性别男性患者实施了不同的尿道成形术，包括尿道口成形术、直视下尿道内切开术、采用颊黏膜移植或皮肤移植的分期约翰森尿道成形术（蒂尔舍 - 杜普莱原理）、非横断性尿道成形术（黑内克 - 米库利茨原理）、切除并一期吻合术，以及两种新技术：耻骨上隧道下尿道闭合术和腹部带蒂皮瓣尿道成形术。每位患者在术后1个月进行常规评估，之后12个月内每3个月评估一次，评估内容包括临床评估、尿流率测定和排尿后残余尿量。
36例患者共进行了41次手术，32例患者（88.8%）最终能够站立排尿。采用中厚皮片移植的分期约翰森尿道成形术、分期腹部带蒂皮瓣尿道成形术以及切除并一期吻合术的成功率最高，而直视下尿道内切开术（成功率0%）和非横断性吻合尿道成形术（成功率50%）的成功率最低。对于分期手术与一期手术的前瞻性分析，26例一期手术中有17例（65.4%）成功，15例分期手术中有13例（86.6%）成功。
阴茎成形术后的尿道并发症需要复杂的手术操作，对手术专业水平要求较高。腹部带蒂皮瓣尿道成形术是治疗长段难治性尿道狭窄的可行选择。
