Cannoletta Donato, Pederzoli Filippo, Yepes Christian, Joshi Pankaj, Salonia Andrea, Briganti Alberto, Montorsi Francesco, Kulkarni Sanjay, Bandini Marco
Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Center for Genital Reconstructive Surgery, Cali, Colombia.
Int J Impot Res. 2025 Mar 19. doi: 10.1038/s41443-025-01040-7.
Urethroplasty has evolved over last decades, with significant improvements in surgical techniques and graft types. In this narrative review, we aimed to explore the evolution of urethroplasty techniques for bulbar urethral strictures. To do this, the review is structured into three main sections: the Historical Background section highlights the seminal contribution from early pioneers to contemporary techniques, which re-gained momentum in reconstructive urology. Starting with the early techniques in the 19th and 20th centuries, we focused on the pioneering innovations of the 1990s, ultimately leading to the most recent tissue-preserving techniques. The second part presents a literature review comparing different graft types and critically evaluating surgical outcomes from multiple original articles and meta-analysis. Specifically, similar success rates were reported for oral and preputial grafts for the treatment of anterior urethral strictures, while long-term outcomes suggest graft deterioration over time. Furthermore, data on optimal surgical techniques remain limited. Lastly, Future Perspectives address ongoing innovations, including new graft and flap combinations for complex strictures, emphasizing the continuous refinement of less invasive, tissue-preserving techniques.
在过去几十年里，尿道成形术不断发展，手术技术和移植物类型都有了显著改进。在这篇叙述性综述中，我们旨在探讨球部尿道狭窄的尿道成形术技术的演变。为此，本综述分为三个主要部分：“历史背景”部分重点介绍了早期先驱者对当代技术的开创性贡献，这些技术在重建泌尿外科领域重新获得了发展势头。从19世纪和20世纪的早期技术开始，我们重点关注了20世纪90年代的开创性创新，最终引出了最新的保留组织技术。第二部分进行了文献综述，比较了不同的移植物类型，并对多篇原始文章和荟萃分析的手术结果进行了批判性评估。具体而言，报道称口腔黏膜移植物和包皮移植物治疗前尿道狭窄的成功率相似，但长期结果表明移植物会随着时间推移而退化。此外，关于最佳手术技术的数据仍然有限。最后，“未来展望”部分讨论了正在进行的创新，包括用于复杂狭窄的新移植物和皮瓣组合，强调了对微创、保留组织技术的不断完善。
