Current trends in urethral stricture management.
Current trends in urethral stricture management.
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DOI：
10.1016/j.ajur.2015.04.005
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发表时间：
2014-10
影响因子：
2.6
通讯作者：
Chapple CR
中科院分区：
文献类型：
--
作者：
Hillary CJ;Osman NI;Chapple CR
最近的2010年国际泌尿系疾病咨询小组确认，尿路狭窄的定义是由于缺血性海绵状纤维化导致的尿路狭窄，有别于括约肌狭窄和尿路断裂损伤。只要有可能，应该进行吻合性尿路成形术，因为与扩大尿路成形术相比，成功率更高。目前对于吻合术的临界狭窄长度仍有一些争论，但很明显，海绵纤维化的程度和个别解剖因素(阴茎和尿路的长度)是重要的，其限制是将剥离范围扩大到阴茎-阴囊交界处以外，以及随后产生的肩索。最近，人们对是否切除和吻合术或使用Heineke-Miculicz技术进行狭窄切开和再吻合术感兴趣。与阴茎皮瓣相比，增大尿路成形术已向更广泛地使用口腔黏膜移植物发展，因为皮瓣和移植物具有相似的疗效，当然，背侧或腹侧定位的使用似乎提供了类似的结果。重要的是，重建外科医生精通所有可用的修复技术，因为没有一种单一的方法适用于所有病例，并且能够处理术中发现的任何意外的解剖发现。
The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury. Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty. There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee. More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique. Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results. It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.