Morey A F, Duckett C P, McAninch J W
Department of Urology, University of California School of Medicine and San Francisco General Hospital, 94143-0738, USA.
J Urol. 1997 Oct;158(4):1383-7. doi: 10.1016/s0022-5347(01)64221-6.
We analyzed the methods and outcomes of repeat urethroplasty in men with recurrent stricture after the failure of previous anterior urethroplasty.
In 31 men with recurrent stricture after previous urethroplasty anterior urethral reconstruction was performed. Reconstructive methods varied according to stricture length and location.
End-to-end urethroplasty performed in 11 of 13 men with short (average 1.8 cm.) bulbar strictures was successful in all. Patch graft urethroplasty was successfully done in 4 men with intermediate (average 4.4 cm.) strictures. Penile circular fasciocutaneous flap urethroplasty performed in 13 of 14 men with long or distal strictures (average 8 cm.) was successful in 10 (79%). Overall excellent results were obtained in 28 of the 31 cases (90%).
Guidelines for urethral reconstruction after failed anterior urethroplasty are predicated on stricture length, location and severity. Circular fasciocutaneous flap urethroplasty is extremely versatile and effective for refractory long or distal strictures. End-to-end urethroplasty with stricture excision is highly reliable for less extensive bulbar strictures for which previous operative repair has failed. Grafts are best used selectively in the reoperative setting.
我们分析了既往前尿道成形术失败后复发性狭窄男性患者再次尿道成形术的方法及结果。
对31例既往尿道成形术后复发性狭窄的男性患者进行了前尿道重建术。重建方法根据狭窄长度和位置而有所不同。
13例球部短狭窄（平均1.8厘米）患者中有11例行端端尿道成形术，全部成功。4例中度狭窄（平均4.4厘米）患者行补片移植尿道成形术成功。14例长段或远端狭窄（平均8厘米）患者中有13例行阴茎环形筋膜皮瓣尿道成形术，10例（79%）成功。31例患者中有28例（90%）总体效果良好。
前尿道成形术失败后尿道重建的指导原则基于狭窄长度、位置和严重程度。环形筋膜皮瓣尿道成形术对难治性长段或远端狭窄极为通用且有效。对于既往手术修复失败的范围较小的球部狭窄，切除狭窄的端端尿道成形术高度可靠可靠。补片移植最好在再次手术时选择性使用。
