Management of Panurethral Stricture Disease in India
Management of Panurethral Stricture Disease in India
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DOI：
10.1016/j.juro.2012.05.020
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发表时间：
2012-09-01
影响因子：
6.6
通讯作者：
Venkatesan, Krishnan
中科院分区：
文献类型：
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作者：
Kulkarni, Sanjay Balwant;Joshi, Pankaj M.;Venkatesan, Krishnan
目的：涉及阴茎和尿道球部的全尿道狭窄是南亚次大陆常见的泌尿外科问题。它是一个特别难以管理的挑战，并且关于该主题的文献相对较少。在印度，硬化性苔藓是全尿道狭窄最常见的病因，其次是医源性原因。我们介绍我们使用口腔粘膜移植物进行一阶段、一侧解剖背侧嵌体修复的全尿道狭窄修复经验。材料和方法：我们回顾性回顾了 1998 年 6 月至 2010 年 12 月连续 117 名接受全尿道狭窄治疗的男性的记录。患者中位年龄为 47.8 岁，平均狭窄长度为 14 厘米，中位随访时间为 59 个月。通过会阴切口接近狭窄处，仅将解剖限制在尿道的一侧。在第一阶段将阴茎内陷以提供到达前尿道整个长度的通路。将两个口腔粘膜移植物置于背侧。结果：如果患者不需要进一步的器械（包括扩张或尿道切开术），则结果被认为是成功的。总体成功率为 83.7%，其中初次尿道成形术的成功率为 86.5%，之前尿道成形术失败的患者成功率为 61.5%。大多数复发性狭窄发生在移植物的近端。结论：单侧解剖和口腔粘膜移植物背侧覆盖的一期修复全尿道狭窄是一种微创技术，简单、快速、安全、有效，任何外科医生都可以重复。
Purpose: Panurethral stricture involving the penile and bulbar urethra is a common urological problem on the South Asian subcontinent. It represents a particularly difficult challenge to manage and there is a relative paucity of literature on the subject. In India lichen sclerosus is the most common etiology of panurethral stricture, followed by iatrogenic causes. We present our experience with panurethral stricture repair using 1-stage, 1-side dissection dorsal onlay repair with oral mucosa grafts.Materials and Methods: We retrospectively reviewed the records of 117 consecutive men who underwent treatment for panurethral stricture from June 1998 to December 2010. Median patient age was 47.8 years, mean stricture length was 14 cm and median followup was 59 months. The stricture was approached through a perineal incision, limiting dissection to only 1 side of the urethra. The penis was invaginated to provide access to the entire length of anterior urethra in 1 stage. Two oral mucosal grafts were placed dorsally.Results: The outcome was considered a success if the patient required no further instrumentation, including dilation or urethrotomy. The overall success rate was 83.7% with a success rate of 86.5% for primary urethroplasty and 61.5% in patients in whom urethroplasty had previously failed. Most recurrent strictures developed at the proximal end of the graft.Conclusions: Repair of panurethral stricture in 1 stage with 1-side dissection and dorsal onlay of oral mucosa graft is a minimally invasive technique that is simple, fast, safe, effective and reproducible by any surgeon.