结肠黏膜一期尿道成形术治疗复杂性超长段尿道狭窄

目的 探讨利用结肠黏膜一期尿道成形术治疗复杂性超长段尿道狭窄或闭锁的应用价值与疗效。方法 2000年10月～2003年5月采用结肠黏膜一期尿道成形术治疗19例复杂性超长段尿道狭窄患者。患者术前有平均3次不成功的尿道修复史,用结肠黏膜重建的尿道长10～17cm,平均13．2cm,术后随访时分别行逆行尿道造影,尿道镜和尿流率检查。结果 本组患者术后随访6～36个月,平均17个月。1例在术后3个月并发尿道外口狭窄,经手术矫正后排尿通畅,术后1年随访时最大尿流率28．7ml／s。另1例在术后14个月行尿道镜检查时发现精阜肥大,将肥大的精阜切除后行尿动力学检查示最大尿流率高达46．5ml／s。余17例术后排尿通畅,最大尿流率大于15ml／s。结论 利用结肠黏膜重建尿道治疗复杂性超长段尿道狭窄或闭锁是一种可行而有效的方法,尤其适合在较多常规方法治疗失败时实施。     

犬结肠黏膜与颊黏膜移植到膀胱后的组织病理学变化

颊黏膜作为一种尿道替代物已在临床上广泛应用,疗效显著。然而,由于颊黏膜材源有限,较难用于10cm以上的长段尿道狭窄的修复,必须选用其他组织替代。近几年来,我们进行犬的结肠黏膜替代尿道的实验研究和将结肠黏膜用于10cm以上较长段尿道狭窄或闭锁修复的临床初步研究,近期效果较好。但是结肠黏膜是否能与颊黏膜一样作为理想的尿道替代物尚不清楚,我们将结肠黏膜与颊黏膜同时移植到膀胱,观察两者在尿液中长期浸泡后的组织病理学变化,并比较两者的差异,从而确定结肠黏膜是否能作为较理想的尿道的替代物。     

结肠粘膜尿道成形术治疗复杂性长段尿道狭窄——附1例报告并文献复习

目的 探讨结肠粘膜尿道成形术治疗复杂性长段尿道狭窄的应用价值与疗效。方法 采用结肠粘膜尿道成形术治疗1例复杂性长段尿道狭窄患者。用结肠粘膜重建的尿道长约10cm。术后随访尿流率检查。结果 术后3周最大尿流率13ml／s；术后6个月最大尿流率23ml／s。术后2年随访，排尿通畅。结论 利用结肠粘膜尿道成形术是治疗复杂性长段尿道狭窄或闭锁的一种可行而有效的方法。     

非离断尿道海绵体结合舌黏膜扩大管腔在男性球部尿道狭窄修复中的疗效观察

目的 观察非离断尿道海绵体技术结合舌黏膜扩大管腔在男性球部尿道狭窄修复重建中的疗效及并发症.方法 男性球部尿道狭窄患者21例,分离出球部狭窄段尿道后,不离断尿道海绵体,纵向剖开尿道管腔,其中尿道狭窄长度在2 cm以内12例,直接行勺状尿道端端吻合.其中尿道狭窄段长度超过2 cm 9例,考虑直接尿道吻合张力大,应用舌黏膜...     

青海地区舌黏膜代尿道在复杂性前尿道狭窄中的临床研究

目的:探讨青海地区应用舌黏膜代尿道在复杂性前尿道狭窄中的临床应用价值,以获得一种较理想的治疗复杂性前尿道狭窄的手术方法.方法:收集2018年1月-2020年1月我院泌尿外科应用舌黏膜代尿道治疗28例复杂性前尿道狭窄男性患者的临床资料,并进行临床随访.随访后,复查尿道造影通畅的23例患者列为手术成功组,3例尿道狭窄及2例...     

改良尿道套入术治疗复杂性后尿道狭窄或闭锁疗效分析

目的 探讨改良尿道套入术治疗复杂性后尿道狭窄或闭锁的临床疗效.方法 选取我院71例行改良尿道套入术治疗的复杂性后尿道狭窄或闭锁患者,狭窄或闭锁段长3～10 cm.62例曾有1～4次手术史.67例经会阴或腹会阴切口,4例经耻骨或切除部分耻骨下缘切口.14例应用游离包皮内板和(或)膀胱黏膜进行尿道替代成形.结果 67例(94.4%)拔管后排尿较满意,其中61例无需尿道扩张,6例尿道扩张3～8次后恢复正常;4例失败.性功能改善7例,恶化2例,余无明显变化.会阴部切口感染3例.结论 改良尿道套入术治疗复杂性后尿道狭窄或闭锁是可行的、安全的,具有创伤小、操作简便、成功率高等优点.     

口腔黏膜及带蒂阴茎皮瓣用于前尿道狭窄患者尿道重建的疗效分析

目的 探讨利用口腔黏膜(下唇黏膜、舌黏膜)、带蒂阴茎皮瓣修复复杂前尿道狭窄的疗效及经验.方法 回顾性分析2012年8月至2018年5月我科收治的因各种原因引起的复杂性男性前尿道狭窄行口腔黏膜移植物或带蒂阴茎皮瓣修复治疗的33例患者资料.对于阴茎包皮组织预估不足、多段尿道狭窄或有尿道手术史的患者采用口腔黏膜移植物尿道成形...     

不同重建方法治疗犬输尿管黏膜剥脱的实验观察

目的 观察不同重建方法对输尿管黏膜剥脱的疗效,探索治疗输尿管黏膜剥脱的新方法.方法 选择成年杂种犬20条,随机分为4组,制作输尿管黏膜剥脱模型后.黏膜缺损处分别予膀胱黏膜或腹膜植入、输尿管黏膜原位回置处理,对照组仅留置支架管.术后10周行静脉肾盂造影（IVP）和病理检查.结果 对照组均产生输尿管腔闭锁或严重狭窄.输尿管黏膜原位回置组和腹膜替代组输尿管腔均无明显狭窄及扩张,重建段新生黏膜生长良好,接近正常输尿管结构.膀胱黏膜组死亡1条,2条重建段上段输尿管轻度扩张,2条输尿管腔无明显狭窄.结论 输尿管黏膜原位回置或采用腹膜重建并留置支架管充分引流治疗输尿管黏膜剥脱疗效理想;膀胱黏膜可作为输尿管黏膜剥脱后重建可选择的修复材料.     

口腔颊黏膜和结肠黏膜修复尿道狭窄的临床观察

目的探索口腔颊黏膜成为修复前尿道狭窄的新型替代材料及其手术方法,提高口腔颊黏膜移植手术的成功率。方法分别从口腔颊黏膜和结肠黏膜切取相应大小的黏膜以补片法修复尿道。结果32例前尿道狭窄患者36次行颊黏膜尿道修复术,术后尿道通畅无继发性狭窄。口腔黏膜10d基本愈合,无不良反应。36例开腹取结肠黏膜修复前尿道狭窄,6例失败。结论口腔颊黏膜取材方便,创伤小,易存活,抗感染力强,复原快,能反复切取,手术简单,效果好。可成为替代结肠黏膜修复前尿道狭窄的材料。     

口腔黏膜移植物尿道成形术治疗硬化性苔藓样变致长段前尿道狭窄的临床分析

目的 探讨口腔黏膜移植物尿道成形术治疗硬化性苔藓样变致长段前尿道狭窄的临床疗效.方法 采用截石位尿道背侧2点～3点纵行切开狭窄段尿道,行尿道扩大成形术.选取34例2014年1月至2018年11月应用口腔黏膜尿道成形术治疗硬化性苔藓样变致长段前尿道狭窄的患者,狭窄段长度为8.0～17.0 cm,平均(11.7±2.6)c...     

Treatment of urethral strictures using lingual mucosas urethroplasty: experience of 92 cases

Background Urethroplasty of complex urethral stricture is a difficult procedure, and there is no widely accepted standard approach described in the published literature. We evaluated the efficacy and safety of urethroplasty using lingual mucosa grafts （LMGs） for the repair of urethral strictures. Methods Between August 2006 and April 2009, 92 cases of urethral strictures （length ranging from 2.5 cm to 18 cm, mean 6.5 cm） were treated using LMGs. Of the 92 patients, 38 with long-segment urethral strictures （9-18 cm） underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty. Results Follow-up was obtained for 3-33 months （mean 17.2 months） postoperatively. Complications occurred in 8 patients, including urinary fistulas in 4 patients; recurrent strictures developed in 4 patients at 3-4 months post-operatively. The remaining patients voided well postoperatively, with peak flows between 14.3 ml/s and 54.6 ml/s （mean 28.4 ml/s）. Conclusions The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.     

Advances in urethroplasty

There has been rapid evolution in management of urethral strictures in the last 3 decades. From the era of dilatation, we have moved to urethral reconstruction. Reinvention of buccal grafts changed the outcomes of urethroplasty. Barbaglis dorsal onlay popularised stricture management across the globe. Kulkarni described a single stage surgery for panurethral stricture. Advances have taken place, and we have moved from transecting to the non-transecting approaches. We describe the various advances in urethral reconstruction in the last decade.     

An experimental study of colonic mucosal graft for urethral reconstruction

目的　探索结肠粘膜重建尿道的可行性。方法　 10条雌性狗在全麻下行游离结肠粘膜替代尿道粘膜的手术。在手术及处死前分别进行尿动力学检查。术后 8～ 16周将狗处死 ,其尿道作病理检查。结果　 1条狗发生尿道狭窄 ,余 9条狗的尿动力学检查提示 :手术前与处死前的最大尿道压之间差异无显著意义(P >0 0 5 )。 10条狗的尿道病理组织学检查提示 :移植于尿道的结肠粘膜全部成活 ,术后 8周处死的狗显示结肠粘膜表面皱襞存在 ,被覆单层低拄状的吸收上皮和杯状细胞 ;术后 12周后处死的狗显示结肠粘膜表面皱襞 ,被覆的单层吸收上皮和杯状细胞消失 ,尿道粘膜大部分已被化生为假多层的移行上皮复盖。结论　结肠粘膜能替代尿道粘膜 ,尿道纵行切开对雌性狗的括约功能影响不大。这种技术尤其适用于包皮或膀胱及颊粘膜应用不合适时的尿道重建     

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

Background

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

Methods

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

Results

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3–16) cm and the operation time 170 (140–210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

Conclusions

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.     

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

Background

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

Methods

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

Results

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3–16) cm and the operation time 170 (140–210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

Conclusions

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.     

犬结肠黏膜与颊黏膜游离补片替代尿道的动物实验研究

目的探讨游离黏膜补片替代尿道的可行性和有效性。方法将20条成年雄性比格犬分为A、B两组进行实验。A组采用颊黏膜补片替代尿道,B组采用结肠黏膜补片替代尿道。分别取4cm×0.8cm大小的颊黏膜补片和结肠黏膜补片来替代A、B两组尿道,术后观察排尿情况,3个月后对犬行逆行尿道造影,并用F8探杆证实有无狭窄。随后处死犬测定移植物长度并作病理组织学检查。结果实验犬全部存活,除3例外均排尿通畅,A组有1例发现尿道狭窄,另有1例出现尿瘘及滴血;B组有2例发现尿道狭窄,另有2例出现尿瘘及滴血。移植物平均皱缩率A组为15.25%,B组为13.75%。移植的颊黏膜和结肠黏膜全部存活,大部分颊黏膜的鳞状上皮上已覆盖假多层的移性上皮细胞,大部分结肠黏膜的腺上皮已覆盖假多层的移性上皮细胞。结论犬的尿道黏膜可用颊黏膜补片和结肠黏膜补片来替代。