Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap.
Urethroplasty for high risk, long segment urethral strictures with ventral buccal mucosa graft and gracilis muscle flap.
复制标题
采用腹侧颊粘膜移植和股薄肌瓣进行尿道成形术治疗高风险、长段尿道狭窄。
DOI：
10.1016/j.juro.2014.09.093
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
A. Vanni
中科院分区：
文献类型：
--
作者：
Drew A Palmer;J. Buckley;L. Zinman;A. Vanni
目的长段尿道狭窄，移植床受损，血管供应不良，不适合标准修复，复发风险高。我们评估了成功的尿道重建在这些患者的腹颊粘膜移植和股薄肌flaps.Materials和MethodsWe回顾性分析了1,039例患者谁接受了尿道成形术在Lahey医院和医疗中心在1999年和2014年之间的记录。我们确定了20例患者接受了尿道成形术与腹颊粘膜移植和股薄肌肌瓣移植床。膀胱狭窄复发的定义为无法通过16 Fr膀胱镜。结果平均狭窄长度为8.2 cm（范围3.5至15）。病变位于后尿道者50%，球膜尿道者35%，球尿道者10%，近侧悬垂尿道者5%。45%的病例的病因是放射治疗，其次是20%的特发性原因，15%的创伤，10%的尿道切除术，尿道下裂失败和经尿道手术各占5%。9例患者（45%）既往接受过尿道成形术治疗，3例（15%）既往接受过UroLume®支架置入术。平均随访40个月，16例（80%）尿道重建成功。治疗失败的患者中有1例接受了回肠袢，2例接受了耻骨上插管，1例接受了尿道扩张。平均复发时间为10个月（范围2至17）。术后5例（25%）有失禁需要人工urinary sphincter.ConclusionsUrethroplasty高风险，长段尿道狭窄，可以成功地进行与腹侧颊粘膜移植和股薄肌皮瓣，避免尿流改道在大多数患者。
PurposeLong segment urethral strictures with a compromised graft bed and poor vascular supply are unfit for standard repair and at high risk for recurrence. We assessed the success of urethral reconstruction in these patients with a ventral buccal mucosa graft and gracilis muscle flap.Materials and MethodsWe retrospectively reviewed the records of 1,039 patients who underwent urethroplasty at Lahey Hospital and Medical Center between 1999 and 2014. We identified 20 patients who underwent urethroplasty with a ventral buccal mucosa graft and a gracilis muscle flap graft bed. Stricture recurrence was defined as the inability to pass a 16Fr cystoscope.ResultsMean stricture length was 8.2 cm (range 3.5 to 15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 50% of cases, and in the bulbomembranous urethra in 35%, the bulbar urethra in 10% and the proximal pendulous urethra in 5%. Stricture etiology was radiation therapy in 45% of cases, followed by an idiopathic cause in 20%, trauma in 15%, prostatectomy in 10%, and hypospadias failure and transurethral surgery in 5% each. Nine patients (45%) were previously treated with urethroplasty and 3 (15%) previously underwent UroLume® stent placement. Urethral reconstruction was successful in 16 cases (80%) at a mean followup of 40 months. One of the patients in whom treatment failed had an ileal loop, 2 had a suprapubic tube and urethral dilatation had been done in 1. Mean time to recurrence was 10 months (range 2 to 17). Postoperatively 5 patients (25%) had incontinence requiring an artificial urinary sphincter.ConclusionsUrethroplasty for high risk, long segment urethral strictures can be successfully performed with a ventral buccal mucosa graft and a gracilis muscle flap, avoiding urinary diversion in most patients.