Anadani Abdulrazak, Obaidin Aya, Badawi Bashar, Lutfi M Yasin
Faculty of Medicine, University of Aleppo, Aleppo, Syria.
Faculty of Medicine, Hama University, Hama, Syria.
Medicine (Baltimore). 2025 Mar 21;104(12):e41888. doi: 10.1097/MD.0000000000041888.
Strictures of the male urethra are common, often caused by trauma or occur idiopathically. The primary clinical symptoms include chronic obstructive voiding issues, and some patients may experience sexual dysfunction. Treatment choices mainly depend on the stricture's location and length.
A 37-year-old man visited the urology department with lower urinary tract symptoms and recurrent urinary tract infections. He had a 5 cm urethral stricture previously treated with urethroplasty, which was unsuccessful.
A retrograde urethrography revealed the stricture, an extra-anatomical bypass, and a diverticulum.
A second urethroplasty was performed, using a combination of a buccal mucosa graft and a penile skin flap.
Postoperative follow-up indicated improvement in the patient's voiding symptoms. A retrograde urethrography was done 3 months after the procedure showing a well-patent urethra with no complications.
The key factors in deciding the treatment for urethral strictures are their location and length. Both grafts and flaps are effective for urethroplasties. However, complex long strictures with damaged urethral plates pose challenges for successful single-stage reconstruction. Combining a dorsal buccal mucosa graft to augment the urethral plate with a ventral onlay penile skin flap is a promising approach, leveraging the benefits of both tissue types. Combining grafts and flaps is advisable for reconstructing complicated urethral strictures with damaged urethral plates. Consulting a more experienced surgeon is recommended to minimize the risk of complications.
男性尿道狭窄很常见，通常由创伤引起或为特发性。主要临床症状包括慢性排尿梗阻问题，部分患者可能出现性功能障碍。治疗选择主要取决于狭窄的位置和长度。
一名37岁男性因下尿路症状和反复尿路感染就诊于泌尿外科。他曾有一段5厘米长的尿道狭窄，之前接受过尿道成形术，但未成功。
逆行尿道造影显示存在狭窄、解剖外旁路和憩室。
进行了第二次尿道成形术，采用颊黏膜移植和阴茎皮瓣联合的方法。
术后随访显示患者排尿症状有所改善。术后3个月进行了逆行尿道造影，结果显示尿道通畅，无并发症。
决定尿道狭窄治疗方案的关键因素是其位置和长度。移植组织和皮瓣对尿道成形术均有效。然而，伴有尿道板损伤的复杂长段狭窄对成功的一期重建构成挑战。将背侧颊黏膜移植以增强尿道板与腹侧阴茎皮瓣覆盖相结合是一种有前景的方法，利用了两种组织类型的优势。对于伴有尿道板损伤的复杂尿道狭窄重建，建议联合使用移植组织和皮瓣。建议咨询经验更丰富的外科医生以将并发症风险降至最低。
