Falandry L, Tidjani A, Guélina G
Service d'Urologie, Centre Hospitalier Universitaire de Niamey, Niger.
J Chir (Paris). 1996;133(8):376-84.
Reported here is our experience with a new procedure using a pedicled labial flap for urethral reconstruction in patients treated for extensive urethral damage after obstetrical injury. From January 1992 to January 1996, 31 cases of urethral damage in African female patients, with an average age of 18-years-old were treated by pedicled labial urethroplasty. This procedure was done by using a pedicled flap obtained from the major labia. The flap was then introduced as in a tunnel beneath the vaginal epithelium reaching the damaged urethra. A variety of techniques were used: the patch to lengthen sufficiency (13 cases), or the tubularized flap following complete reconstruction of the urethra (21 cases). Good quality urine continence was obtained by using the suburethral Martius' sling procedure. In 6 cases, we combined the treatment with a colposuspension procedure. The average follow-up is 14 months (ranging from 6 to 37 months). Recovery of normal micturition with absence of urinary leak was obtained in 21/30 cases (70%). While 5 moderate failures occurred, 4 cases were considered complete failures. In view of the high success rate, the authors consider that the one-stage procedure by the use of a pedicled labial flap is a choice treatment and highly suitable procedure for the management of extensive urethral cervical damage after obstetrical injury.
本文报告了我们使用带蒂阴唇皮瓣进行尿道重建的新方法治疗产科损伤后广泛性尿道损伤患者的经验。1992年1月至1996年1月，对31例平均年龄18岁的非洲女性尿道损伤患者采用带蒂阴唇尿道成形术进行治疗。该手术通过取自大阴唇的带蒂皮瓣完成。然后将皮瓣像在隧道中一样引入阴道上皮下方到达受损尿道。采用了多种技术：补片以延长尿道（13例），或在尿道完全重建后采用管状皮瓣（21例）。通过尿道下Martius吊带手术获得了良好的尿控效果。6例患者我们将该治疗与阴道悬吊术联合应用。平均随访14个月（6至37个月）。30例患者中有21例（70%）恢复了正常排尿且无尿漏。出现了5例中度失败，4例被认为是完全失败。鉴于成功率较高，作者认为使用带蒂阴唇皮瓣的一期手术是治疗产科损伤后广泛性尿道宫颈损伤的一种选择治疗方法且是非常合适的手术。
