Martínez-Piñeiro J A, Cárcamo P, García Matres M J, Martínez-Piñeiro L, Iglesias J R, Rodríguez Ledesma J M
Urological Service, Universitary Hospital La Paz, Faculty of Medicine, Universidad Autónoma, Madrid, Spain.
Eur Urol. 1997;32(4):433-41.
To analyze the results of a series of end-to-end urethroplasties performed in our service from 1968 to 1995 and of the factors contributing to failure.
150 men (mean age 35.9 years) with urethral stricture disease underwent excision of the stricture and end-to-end anastomosis; in 95 it was the first attempt at repair while in 55 it was a secondary attempt. Eighty-two patients (54.6%) had a trauma-related stricture; of them, 56 followed a pelvic ring fracture with posterior urethra distraction defect, 24 (16%) had inflammatory strictures, 26 (17.3%) iatrogenic, 9 (6%) congenital, and 9 (6%) of unknown etiology; 81 (54%) were located in the bulbous urethra, 9 (6%) in the penoscrotal junction and 2 (1.3%) in the penile urethra. Ninety-one (60.6%) of the strictures or obliterative defects measured between 1 and 3 cm, 42 (28%) less than 1 cm and only 16 (10.6%) more than 3 cm. A perineal approach was used in 138 of the cases, while combined abdominoperineal route was necessary in 12; of these, 5 were children. The follow-up has ranged from 6 to 168 months (mean 44.4). The results were classified as good, fair (some re-stricturing, not needing treatment) and poor (recurrence).
One hundred and twenty-six (84%) good outcomes, 10 (6.6%) fair, 14 (9.3%) poor. The factors influencing success or failure were: (1) primary or secondary character of the operation; (2) etiology; (3) length, and (4) location. Postoperative early complications consisted of 2 wound infections and 2 hematomas; as late complications, 1 chordee, 2 incontinence, 7 erectile dysfunction (in previously potent patients). The 14 patients considered as failures were operated again, all successfully; in 4 of them, a repeat excision and end-to-end anastomosis was performed, elevating the final success rate of the series to 93.3%.
Excision and anastomotic repair represent the optimal mode of stricture repair for single lesions located from the penoscrotal junction to the membranous part of the urethra.
分析1968年至1995年在我院进行的一系列端端尿道成形术的结果以及导致手术失败的因素。
150例患有尿道狭窄疾病的男性（平均年龄35.9岁）接受了狭窄段切除及端端吻合术；其中95例为首次修复尝试，55例为二次修复尝试。82例患者（54.6%）的狭窄与创伤相关；其中，56例继发于骨盆环骨折伴后尿道牵张缺损，24例（16%）为炎性狭窄，26例（17.3%）为医源性狭窄，9例（6%）为先天性狭窄，9例（6%）病因不明；81例（54%）狭窄位于球部尿道，9例（6%）位于阴茎阴囊交界处，2例（1.3%）位于阴茎尿道。91例（60.6%）狭窄或闭塞性缺损长度在1至3厘米之间，42例（28%）小于1厘米，仅16例（10.6%）大于3厘米。138例采用会阴入路，12例需要联合腹会阴途径；其中5例为儿童。随访时间为6至168个月（平均44.4个月）。结果分为良好、尚可（有一些再狭窄，无需治疗）和差（复发）。
126例（84%）结果良好，10例（6.6%）尚可，14例（9.3%）差。影响成败的因素包括：（1）手术的初次或二次性质；（2）病因；（3）长度；（4）位置。术后早期并发症包括2例伤口感染和2例血肿；晚期并发症包括1例阴茎下弯、2例尿失禁、7例勃起功能障碍（既往有勃起功能的患者）。14例被视为手术失败的患者再次接受手术，均获成功；其中4例行再次切除及端端吻合术，使该系列手术的最终成功率提高至93.3%。
切除及吻合修复是阴茎阴囊交界处至尿道膜部单发狭窄修复的最佳方式。
