Wessells H, Morey A F, McAninch J W
Department of Urology, University of California School of Medicine, USA.
J Urol. 1997 Apr;157(4):1271-4.
Reconstruction of most urethral strictures is possible with anastomotic, graft or skin flap procedures alone. We describe the combination of tissue transfer techniques to preserve the urethral plate and reconstruct long and complex urethral strictures in 1 stage.
We reviewed the results in 25 patients who underwent anterior urethroplasty requiring more than 1 tissue transfer technique to achieve urethral reconstruction in 1 stage.
Outcome was excellent in 22 patients (88%). Seven patients with pan-urethral strictures (mean length 19 cm.) required a fasciocutaneous flap combined with a buccal mucosa, bladder epithelium or skin graft. A total of 13 patients with focally dense strictures underwent excision of the most severe portion of the stricture with dorsal reapproximation, thereby improving the quality of the urethral plate and allowing simultaneous flap or graft onlay reconstruction. Five patients with multiple separate strictures required a distal onlay fasciocutaneous flap with excision and end-to-end anastomosis of a separate, more proximal stricture.
A thorough knowledge of the vascular supply of the urethra allowed creative application of different tissue transfer techniques, enabling 1-stage reconstruction of complex urethral strictures. An excellent outcome was achieved by preserving or revising the urethral plate and avoiding the problems associated with hair-bearing flaps and 2-stage procedures.
大多数尿道狭窄仅通过吻合、移植或皮瓣手术即可重建。我们描述了联合组织转移技术以保留尿道板并一期重建长段和复杂尿道狭窄的方法。
我们回顾了25例接受前尿道成形术的患者的结果，这些患者需要不止一种组织转移技术来一期完成尿道重建。
22例患者（88%）预后良好。7例全尿道狭窄患者（平均长度19厘米）需要筋膜皮瓣联合颊黏膜、膀胱上皮或皮肤移植。共有13例局灶性致密狭窄患者接受了狭窄最严重部分的切除及背侧重新对合，从而改善了尿道板的质量，并允许同时进行皮瓣或移植片覆盖重建。5例多处孤立狭窄患者需要远端覆盖筋膜皮瓣，并切除一处单独的、更靠近近端的狭窄并进行端端吻合。
对尿道血供的深入了解使得不同组织转移技术得以创造性应用，从而能够一期重建复杂尿道狭窄。通过保留或修复尿道板并避免与带毛发皮瓣及二期手术相关的问题，取得了良好的预后。
