The augmented anastomotic urethroplasty: Indications and outcome in 29 patients
The augmented anastomotic urethroplasty: Indications and outcome in 29 patients
复制标题
DOI：
10.1016/s0022-5347(05)66335-5
复制
发表时间：
2001-05-01
影响因子：
6.6
通讯作者：
Webster, GD
中科院分区：
文献类型：
--
作者：
Guralnick, ML;Webster, GD
目的：1cm或更短的球部狭窄最好采用狭窄切除和一期吻合术，然而，当狭窄的总长度太大而无法切除和吻合时，存在一个两难的选择，包括狭窄切开和皮瓣移植物覆盖或狭窄切除加顶或底条吻合加覆盖。我们报告我们的结果与后一种类型的加强吻合尿道成形术。材料和方法：我们回顾性审查。1990年至1999年间，29例患者接受了尿道扩大吻合术。术后3周和3个月进行逆行尿道造影，如果患者有症状，则稍后进行。在可能的情况下，后续的临床笔记和X线片从参考医生获得和患者直接接触，以评估长期outcome.Results：狭窄是在延髓。所有情况下的尿道。6例患者出现完全闭塞性狭窄。平均狭窄长度为1.5cm。平均切除长度为1.2cm。在29例患者中，9例采用腹侧高嵌体增强屋顶条吻合，20例采用背侧高嵌体形成地板条吻合。嵌体包括7例带蒂皮瓣和22例移植物。平均高嵌体长度为4.5 cm，平均随访28个月（范围3 - 126），29例患者中有27例（93%）无狭窄，所有接受调查的患者对手术满意。术后并发症包括勃起功能障碍1例，排尿后滴尿13例，假性憩室形成2例，自觉阴茎短缩5例。结论：扩大吻合尿道成形术是一种有效的治疗尿道狭窄的方法。超过90%的患者无狭窄，结果似乎持久，但需要更长的随访时间。并发症很少且轻微。
Purpose: A short bulbar stricture of 1 cm, or less is best managed by stricture excision and primary anastomosis, However, a dilemma exists when the total length of the stricture is too great for excision and anastomosis, Options include stricture incision and flap-graft onlay or stricture excision with roof or floor strip anastomosis augmented by an onlay. We report our results with the latter type of augmented anastomotic urethroplasty.Materials and Methods: We retrospectively reviewed the. char ts of 29 patients who underwent augmented anastomotic urethroplasty between 1990 and 1999. Retrograde urethrography was performed 3 weeks and 3 months postoperatively, and later if the patient was symptomatic. When possible, followup clinic notes and x-rays from referring physicians were obtained and patients were contacted directly to assess the long-term outcome.Results: The stricture was in the bulbar. urethra in all cases. Six patients had a completely obliterative stricture. Mean stricture length was 1.5 cm. on retrograde urethrography and the mean excised length was 1.2 cm. In 9 of the 29 patients a roof strip anastomosis was augmented by a ventral onlay and in 20 a floor strip anastomosis was formed with a dorsal onlay. Onlays included a pedicled skin flap in 7 cases and a graft in 22. Mean onlay length was 4.5 cm, At a mean followup of 28 months (range 3 to 126) 27 of the 29 patients (93%) were stricture-free and all those surveyed were satisfied with the procedure. Complications include new erectile dysfunction in 1 patient, post-void dribbling in 13, pseudodiverticulum formation in 2 and subjective penile shortening in 5.Conclusions: Augmented anastomotic urethroplasty is a useful technique for strictures that are too long to be managed by excision and primary anastomosis. Greater than 90% of the patients are stricture-free and the results seem durable, although longer followup is needed. Complications are few and minor.