Ennemoser O, Colleselli K, Reissigl A, Poisel S, Janetschek G, Bartsch G
Department of Urology, University of Innsbruck, Austria.
J Urol. 1997 Feb;157(2):499-505. doi: 10.1016/s0022-5347(01)65187-5.
We describe the anatomy, surgical approach and long-term results of posterior urethral stricture repair.
Between 1975 and 1991, 86 patients underwent surgery for posttraumatic posterior urethral stricture. In 65 patients the urethral lesion was corrected by 1-stage reconstructive surgery via the perineal approach. In 21 patients the urethra was reconstructed with a 2-stage procedure. In an anatomical study the course of the urethra through the pelvic floor was investigated and the concomitant structures were dissected. According to the anatomy a perineal approach was used in 7 male adult cadavers.
Due to the optimized anastomotic technique urinary flow rates of more than 20 ml. per second could be achieved in 29 of all 42 patients followed. Only 6 of these patients had peak urinary flow rates of less than 15 ml. per second. No patient had any recurrent strictures at the anastomotic site that would have required surgical revision.
Our results suggest that adequate primary care and the perineal approach combined with an exact anastomosis technique are essential for successful treatment of posttraumatic strictures of the posterior urethra.
我们描述后尿道狭窄修复术的解剖结构、手术入路及长期结果。
1975年至1991年间，86例患者接受了创伤性后尿道狭窄手术。65例患者经会阴入路通过一期重建手术矫正尿道病变。21例患者采用二期手术重建尿道。在一项解剖学研究中，研究了尿道穿过盆底的走行并解剖了相关结构。根据解剖结构，对7具成年男性尸体采用会阴入路。
由于采用了优化的吻合技术，在随访的42例患者中，有29例患者的尿流率超过每秒20毫升。这些患者中只有6例的尿流峰值率低于每秒15毫升。没有患者在吻合部位出现需要手术修正的复发性狭窄。
我们的结果表明，充分的初级护理、会阴入路结合精确的吻合技术对于创伤性后尿道狭窄的成功治疗至关重要。
