Zhu Wei-Dong, Guo Hui, Xie Hong, Song Lu-Jie, Xu Yue-Min
Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China.
Transl Androl Urol. 2025 Feb 28;14(2):432-440. doi: 10.21037/tau-24-443. Epub 2025 Feb 25.
The optimal surgical approach for complex proximal urethral strictures remains unclear. This study evaluates the outcomes of 11 male patients with complex proximal urethral obliteration and 16 female patients with complete urethral stricture or absence, all treated with urethral reconstruction using an anterior bladder wall flap.
In this retrospective study, 11 male patients and 16 female patients with complex urethral obliteration or absence were treated from January 1990 to December 2023. Causes included traumatic urethral injury, urethral cancer, and congenital bladder exstrophy. All patients had a closed bladder neck and proximal urethral obliteration or absence, confirmed by urethrography, and underwent reconstruction with an anterior bladder wall flap. Postoperative outcomes were assessed by voiding cystourethrogram and uroflowmetry.
The mean age was 29.3 (range, 4-63) years in 11 male patients and 37.1 (range, 4-73) years in 16 female patients. The mean stricture length in male patients was 7.1 (range, 5-15) and 3.6 (range, 3-5) cm in 16 female patients with complete absence of the urethra or stricture. The mean postoperative follow-up duration was 56.5 (range, 13-350) months. Urethral complications developed in 10 patients (37%), including dysuria in 4 (14.8%) cases, two in male patients and two in female patients, stress incontinence in 6 (22.2%), two in male patients and four in female patients; irregular edema or prolapse of the new urethra mucosa in the bladder neck caused obstruction in two male patients and one in female patient, while the cause was urethral external meatal stenosis in another one case. These patients could easily void after resection of the prolapsed mucosa or meatoplasty via the flap. A supplementary vaginoplasty procedure was performed in four female patients.
Reconstruction of the urethra using an anterior bladder wall flap is an effective technique. This treatment of urethral reconstruction can not only achieve anatomical restoration, but also restore functional urinary continence. Small bladder capacity and inflammation can prevent successful urethra reconstruction using a bladder wall flap.
复杂近端尿道狭窄的最佳手术方法仍不明确。本研究评估了11例男性复杂近端尿道闭锁患者和16例女性完全尿道狭窄或缺失患者的治疗结果，所有患者均采用膀胱前壁皮瓣进行尿道重建。
在这项回顾性研究中，1990年1月至2023年12月期间对11例男性和16例女性复杂尿道闭锁或缺失患者进行了治疗。病因包括创伤性尿道损伤、尿道癌和先天性膀胱外翻。所有患者膀胱颈闭合且近端尿道闭锁或缺失，经尿道造影证实，并采用膀胱前壁皮瓣进行重建。术后通过排尿性膀胱尿道造影和尿流率测定评估结果。
11例男性患者的平均年龄为29.3岁（范围4 - 63岁），16例女性患者的平均年龄为37.1岁（范围4 - 73岁）。男性患者的平均狭窄长度为7.1厘米（范围5 - 15厘米），16例完全尿道缺失或狭窄的女性患者为3.6厘米（范围3 - 5厘米）。术后平均随访时间为56.5个月（范围13 - 350个月）。10例患者（37%）出现尿道并发症，包括排尿困难4例（14.8%），男性2例，女性2例；压力性尿失禁6例（22.2%），男性2例，女性4例；膀胱颈新尿道黏膜不规则水肿或脱垂导致2例男性患者和1例女性患者梗阻，另1例病因是尿道外口狭窄。这些患者在切除脱垂黏膜或通过皮瓣进行尿道口成形术后能够轻松排尿。4例女性患者进行了补充性阴道成形术。
采用膀胱前壁皮瓣重建尿道是一种有效的技术。这种尿道重建治疗不仅可以实现解剖学修复，还能恢复功能性尿失禁。膀胱容量小和炎症会妨碍使用膀胱壁皮瓣成功进行尿道重建。
