Carr L K, MacDiarmid S A, Webster G D
Department of Reconstructive Urology and Urodynamics, Duke University Medical Center, Durham, North Carolina, USA.
J Urol. 1997 Jan;157(1):104-8.
Treatment of complex anterior urethral strictures complicated by a lack of sufficient penile skin for primary flap repair has generally consisted of 2-stage scrotal inlay urethroplasty. Scrotal skin has shortcomings, most notably hair formation, diverticula and stricture recurrence from urine induced dermatitis. As an alternative, we present our results with staged mesh graft urethroplasty using split-thickness skin, which is nonhair-bearing, easier to size and seemingly less permeable to urine penetration.
Between 1990 and 1995, 20 men underwent mesh graft urethroplasty for complex strictures, most after failed urethroplasty. Meshed split-thickness skin graft from the thigh (17 men) or full-thickness foreskin (3) was used.
Overall median time to closure was 5.5 months, and 6 men required revision before closure (revision of ostia in 3, chordee release in 2 and lysis of graft adhesions in 1). A successful outcome, as evidenced by retrograde urethrography and history, was achieved in 12 of 15 men (80%) with a median followup of 38 months. Five men have not undergone closure due to patient refusal (2) or because the graft is not ready to be closed (3). Of the failures 2 men had retrograde urethrographic evidence of stricture at the proximal anastomosis and 1 had recurrent stenosis of the entire neourethra by 2 years.
Mesh graft urethroplasty is not a panacea but it is a valuable adjunct in the treatment of complex urethral strictures, offering comparable results to and benefits over scrotal inlay procedures. In a significant percentage of cases it is a multistage rather than a 2-stage procedure.
对于因缺乏足够阴茎皮肤而无法进行一期皮瓣修复的复杂性前尿道狭窄，其治疗通常采用两期阴囊镶嵌尿道成形术。阴囊皮肤存在缺点，最显著的是毛发形成、憩室以及因尿液引起的皮炎导致狭窄复发。作为一种替代方法，我们展示了使用中厚皮片进行分期网状移植尿道成形术的结果，中厚皮片无毛发生长，更容易塑形，且似乎对尿液渗透的通透性更低。
1990年至1995年间，20名男性因复杂性狭窄接受了网状移植尿道成形术，大多数患者此前尿道成形术失败。使用了来自大腿的中厚网状皮片移植（17名男性）或全厚包皮（3名）。
总体闭合中位时间为5.5个月，6名男性在闭合前需要进行修复（3名修复尿道口，2名松解阴茎下弯，1名松解移植皮片粘连）。15名男性中有12名（80%）取得了成功结果，逆行尿道造影和病史证实了这一点，中位随访时间为38个月。5名男性因患者拒绝（2名）或移植皮片未准备好闭合（3名）而未进行闭合。在失败的病例中，2名男性逆行尿道造影显示近端吻合口有狭窄，1名男性在2年内整个新尿道出现复发性狭窄。
网状移植尿道成形术并非万灵药，但它是治疗复杂性尿道狭窄的一种有价值的辅助方法，与阴囊镶嵌手术相比，效果相当且有优势。在相当比例的病例中，它是一个多期而非两期的手术。
