Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture
Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture
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DOI：
10.1186/s12894-019-0466-4
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发表时间：
2019-05-16
期刊：
影响因子：
2
通讯作者：
Gawish, Maher
中科院分区：
文献类型：
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作者：
Selim, Mohamed;Salem, Shady;Gawish, Maher
BackgroundLong前尿道狭窄由于各种病因构成了重建的挑战。我们评估了我们中心的经验，由于不同的病因，通过2阶段替代尿道成形术使用颊粘膜移植procedure.MethodsDuring 2009年11月和2016年11月之间的时间。所有在我科计划进行替代尿道成形术的长前尿道狭窄病例均纳入本研究。第一期手术切除尿道板大部分纤维化区域，保留尿道部分切开，6- 9个月后用颊粘膜移植物填充尿道，第二期手术缝合。一期手术后漏诊18例。年龄17- 60岁，平均38.4岁。狭窄长度4- 13 cm，平均8.3 cm。其中特发性狭窄47例，炎症性狭窄15例，硬化性苔藓26例，尿道下裂术后狭窄35例。第一阶段并发移植物挛缩，11例（8.9%）患者需要再次移植，5例（4.1%）患者颊粘膜部位出血，需要止血缝合，7例（5.7%）患者报告口腔麻木。二期手术并发切口裂开2例（1.9%），狭窄11例（10.5%），瘘管6例（5.7%），外耳道狭窄3例（2.9%）。总的成功率为79.1%（83例105），平均（范围）随访34.7（10- 58个月）。ConclusionsStaged尿道成形术颊粘膜移植程序是一种有效的手术选择，特别是对患者的长前尿道狭窄硬化性苔藓和那些失败的先前的手术修复。
BackgroundLong anterior urethral stricture due to variable etiological factors constitutes a challenge for reconstruction.We evaluated our centers experience with cases of long anterior urethral stricture due to different etiologies that were managed by 2-stage substitution urethroplasty using buccal mucosal graft procedure.MethodsDuring the period between November 2009 and November 2016. All cases with long anterior urethral stricture that were planned for substitution urethroplasty in our department were enrolled in this study. The first stage was excision of most fibrotic areas of the urethral plate, the remaining of the urethra is laid open and augmented with buccal mucosal graft for second stage closure after 6-9months.ResultsThe study included 123 patients who underwent first stage, 105 patients of them underwent second stage urethroplasty. Eighteen cases were missed after first stage. The mean (range) age was 38.4 (17-60years). The mean (range) stricture length was 8.3 (4-13cm). The cause of stricture was idiopathic in 47, inflammatory in 15, lichen sclerosus in 26 and post failed hypospadias repair in 35 patients. First stage was complicated by graft contracture in 11 (8.9%) patients that needed re-grafting, 5(4.1%) patient had bleeding from the buccal mucosa site that needed haemostatic sutures, oral numbness was reported in 7 (5.7%) patients. Second stage was complicated by wound dehiscence in 2(1.9%) patients, restricture in 11 (10.5%), fistula in 6 (5.7%) patients, meatal stenosis in 3 (2.9%). The overall success rate was 79.1% (83 cases out of 105) with a mean (range) follow-up of 34.7 (10-58months).ConclusionsStaged urethroplasty using buccal mucosal graft procedure is an effective surgical option for patients with long anterior urethral strictures especially for patients with lichen sclerosus and those with failed previous surgical repair.