Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?
Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: Are results affected by the surgical technique?
复制标题
DOI：
10.1097/01.ju.0000169422.46721.d7
复制
发表时间：
2005-09-01
影响因子：
6.6
通讯作者：
Lazzeri, M
中科院分区：
文献类型：
--
作者：
Barbagli, G;Palminteri, E;Lazzeri, M
目的：颊粘膜移植尿道成形术是目前最广泛的球尿道狭窄修复方法。根据外科医生的经验和喜好，移植物可放置在尿道腹侧或背侧表面。我们通过比较三种类型的颊粘膜球尿道成形术的效果来研究手术技术是否会影响结果。材料与方法：对50例球型尿道狭窄进行了口腔修复。从1997年到2002年的粘膜移植。患者平均年龄42岁。狭窄的病因为缺血12例，外伤6例，内固定4例，不明原因28例。没有包括硬苔、尿道下裂或尿道成形术失败及狭窄延伸至阴茎尿道的患者。共有47例患者（94%）曾接受过尿道切开或扩张手术。颊粘膜移植物通常采用两组入路从颊部获取。平均接枝长度为4.2 cm。移植物分别放置于球尿道腹面17例、球尿道背面27例、球尿道外侧6例。临床结果被认为是成功或失败的时候，任何术后手术的需要，包括扩张。平均随访42个月（12 ~ 76个月）。结果：50例患者中，成功42例（84%），失败8例（16%）。17例腹侧移植物成功14例（83%），失败3例（17%）。27例背侧移植物成功23例（85%），失败4例（15%）。6例外侧移植物成功5例（83%），失败1例（17%）。无手术并发症。吻合口（2例远端，3例近端）和整个移植区3例失败。5例行尿道切开术，3例行2期尿道成形术。结论：根据我们的经验，在球尿道的腹侧、背侧或外侧表面放置颊粘膜移植物具有相同的成功率（83%至85%），并且结果不受手术技术的影响。此外，狭窄复发在所有患者中分布均匀。
Purpose: The use of buccal mucosa graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. The graft may be placed on the ventral or dorsal urethral surface according to surgeon experience and preference. We investigated whether the results are affected by the surgical technique by comparing the outcome of 3 types of bulbar urethroplasty using buccal mucosa graft.Material and Methods: We repaired 50 bulbar urethral strictures with buccal. mucosa grafts from 1997 to 2002. Mean patient age was 42 years. The etiology of stricture was ischemia in 12 cases, trauma in 6, instrumentation in 4 and unknown in 28. Patients with lichen sclerosus, failed hypospadias or urethroplasty and stricture extending into the penile urethra were not included. A total of 47 patients (94%) had undergone previous urethrotomy or dilation. The buccal mucosa graft was always harvested from the cheek using a 2 team approach. Mean graft length was 4.2 cm. The graft was placed on the ventral, dorsal and lateral bulbar urethral surface in 17, 27 and 6 cases, respectively. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 42 months (range 12 to 76).Results: Of 50 cases 42 (84%) were successful and 8 (16%) failed. The 17 ventral grafts provided success in 14 cases (83%) and failure in 3 (17%). The 27 dorsal grafts provided success in 23 cases (85%) and failure in 4 (15%). The 6 lateral grafts provided success in 5 cases (83%) and failure in 1 (17%). No surgical complications were observed. Failures involved the anastomotic site (distal in 2 and proximal in 3) and the whole grafted area in 3 cases. They were treated with urethrotomy in 5 cases and 2-stage urethroplasty in 3.Conclusions: In our experience the placement of buccal mucosa grafts into the ventral, dorsal or lateral surface of the bulbar urethra showed the same success rates (83% to 85%) and the outcome was not affected by the surgical technique. Moreover, stricture recurrence was uniformly distributed in all patients.