口颊黏膜在尿道成形中的应用

随着尿道成形术的不断改进,近年来,以口颊黏膜替代尿道粘膜在尿道成形术中得到了广泛的应用,并引起了泌尿外科医师的重视.本文主要介绍口颊黏膜替代尿道黏膜在治疗尿道狭窄和尿道下裂中的临床应用及优势,并对该方法在尿道成形术中的进展及目前存在的争议作简要的阐述.     

口颊黏膜在尿道重建中的应用

随着尿道重建技术的不断改进,口颊黏膜替代尿道成形术逐渐成为前尿道缺损修复的最佳选择。本文主要对口颊黏膜的优势特点作一介绍,并阐述口颊黏膜替代尿道成形术在前尿道狭窄和尿道下裂中的临床应用和进展。     

口腔黏膜在尿道修复术中的应用

1998年7月～2004年3月,我院在尿道修复术中采用口腔黏膜替代尿道,修复10例,效果满意.报告如下.     

颊黏膜尿道成形术治疗前尿道狭窄的临床分析

目的 探讨利用游离口腔颊黏膜尿道成形术治疗前尿道狭窄的疗效.方法 2011年6月至2012年12月采用颊黏膜腹侧扩大替代尿道成形术治疗25例前尿道狭窄,狭窄段长度为3.5～10 cm,平均5.74 cm.术前耻骨上膀胱造瘘16例,余9例术前最大尿流率2.4～7.6 mL/s,平均4.3 mL/s.结果 术后随访3～18个月,平均6.5个月.术后患者排尿通畅22例(88％),尿动力学检查显示最大尿流率为14～28mL/s,平均19.4 mL/s.3例(12％)吻合口处狭窄,经历尿道扩张后,排尿通畅.所有患者均无感染及尿道皮肤瘘发生,口腔颊黏膜移植物均成活.结论 口腔颊黏膜可作为较理想的尿道替代物,适合长段或多段狭窄的尿道修复.     

口腔内黏膜尿道成形治疗前尿道狭窄10年经验总结

目的 探讨口腔内黏膜尿道成形治疗尿道狭窄的长期效果. 方法 2001年1月至2010年12月,应用口腔内黏膜(颊黏膜和舌黏膜)尿道成形治疗前尿道狭窄255例.尿道狭窄段长度3 ～18 cm,平均6 cm.尿道成形采用保留原尿道板的扩大尿道成形术或埋藏黏膜条背侧替代尿道成形术.对49例尿道狭窄段≥8 cm者采取双侧颊黏膜拼接、颊粘膜与舌黏膜拼接或双侧连续长条舌黏膜尿道成形. 结果 术后随访8 ～120个月,平均37个月.230例患者排尿通畅,尿线粗,最大尿流率为16～51 ml/s,平均26 ml/s.尿道造影显示重建段尿道管腔通畅.总成功率90.2％.25例患者于术后1年内发生并发症,其中尿道再次狭窄17例,尿道皮肤瘘8例.17例尿道再狭窄患者中15例再次行口腔内黏膜尿道成形,2例吻合口狭窄行尿道内切开,术后排尿通畅;8例尿道皮肤瘘均接受尿瘘修补术后治愈. 结论 口腔颊黏膜和舌黏膜均是良好的尿道替代物,舌黏膜取材较颊黏膜更为便利;口腔内多种黏膜的组合移植重建尿道是治疗长段前尿道狭窄( ≥8 cm)的有效方法.     

影响口腔黏膜尿道成形治疗复杂性尿道狭窄疗效的相关因素

目的：探讨口腔黏膜尿道成形治疗复杂性尿道狭窄影响疗效的相关因素。方法：对采用口腔黏膜替代尿道成形术76例患者的尿道狭窄位置与长度、口腔黏膜宽度、术前手术次数、支架管留置时间等与狭窄复发率进行单因素分析。结果：76例随访3～60个月,平均24．1个月,术后初期排尿通畅61例（80．3％）;再次狭窄15例,其中3例同时伴尿道皮肤瘘,4例伴尿道假性憩室。2例经数次尿道扩张、8例再次手术后排尿通畅,总成功率为93．4％。结论：尿道狭窄复发率与黏膜宽度明显相关（P〈0．05）。在0．8～2．0cm范围内口腔黏膜条越宽,尿道狭窄发生率越低;狭窄长度与术前手术次数对短期狭窄复发率无明显影响。     

组织工程口腔黏膜尿道成形的临床应用

英国谢菲尔德的研究小组报道应用组织工程技术口腔黏膜治疗5例尿道狭窄患者.5例患者均为硬化性萎缩性苔藓所致尿道狭窄,其中3例为长段前尿道狭窄,2例为阴茎部及球部尿道狭窄.3例患者曾经历过1次失败的尿道成形术,2例曾多次行尿道内切开术.     

口腔黏膜微粒在尿道和阴道重建中的应用

目的 探讨口腔黏膜微粒在尿道和阴道重建中的应用方法.方法 自2004年始,我们采用明胶海绵承托黏膜游离移植加硅胶模具支撑的方法,将口腔黏膜微粒应用于尿道重建12例和阴道重建14例,共治疗26例患者.同期选取相同例数同种类型的患者作为对照组,采取常用的手术方法进行治疗(尿道下裂采用口腔黏膜耦合包皮瓣的方法重建尿道,阴道缺失采用多孔全厚皮片游离移植的方法进行阴道重建).结果 实验组26例患者中24例均取得良好的临床效果,2例用于进行尿道重建的患者出现了并发症,1例出现了尿瘘,1例出现了尿道外口狭窄,均经二次手术治愈.对照组14例阴道再造患者中13例患者顺利治愈,1例因剥离阴道腔穴时出现直肠瘘,未能完成再造手术;对照组12例尿道下裂患者中11例治愈,1例出现轻微尿瘘,6个月后再次手术治愈.结论 口腔黏膜微粒是补充黏膜缺损的良好材料,成活容易、生长迅速,术后收缩较小,可以应用于部分尿道重建和阴道重建等被覆黏膜结构器官的再造.     

口腔黏膜尿道重建术

1990-1996年作者医院使用口腔黏膜行尿道重建108例，其中尿道下裂62例，尿道狭窄46例。尿道下裂组患者平均手术治疗3．8次，其中尿道下裂废用者26例，阴茎型14例，会阴型10例，阴茎阴囊型12例。尿道狭窄组中球部狭窄25例，阴茎部狭窄21例，狭窄长度4．2(2～17)cm，平均手术3．3次(sachse尿道内切开术)。取颊部内侧或(加)上／下唇黏膜方法：在唇红部边缘标出需取的黏膜瓣范围，角上作4针牵引线，黏膜下注射含1／10万肾上腺素的生理盐水或局部麻醉药，     

舌黏膜与颊黏膜或包皮拼接重建尿道治疗长段尿道狭窄

目的 探讨舌黏膜与颊黏膜或包皮拼接尿道成形治疗多节段或长段尿道狭窄的安全性和治疗效果.方法 尿道狭窄患者11例,年龄24～56岁,平均32岁.其中前尿道长段狭窄7例,狭窄长度10～15 cm,平均12 cm;尿道2～3处狭窄4例.病程6个月～8年.取舌黏膜条与颊黏膜条拼接尿道成形治疗7例,舌黏膜条与包皮瓣拼接尿道成形治疗4例.结果 11例手术顺利.1例舌黏膜与包皮拼接尿道成形患者术后3个月并发尿道外口狭窄,经手术矫正后排尿通畅,术后8个月最大尿流率27.5 ml/s.余10例排尿通畅、尿线粗,术后随访5～12个月,平均10个月,最大尿流率21～36 ml/s,平均26.8 ml/s.结论 舌黏膜与颊黏膜或包皮拼接尿道成形具有取材方便、患者创伤小的特占点,是治疗长段尿道律窄的较好术式.尤其适用于尿道多处狭窄者.     

Technique of Harvesting Buccal Mucosa for Urethral Reconstruction

Purpose

Buccal mucosa has been used increasingly by urologists for urethral substitution in complex hypospadias repair. We have found buccal mucosa to be useful in reconstruction of bulbar urethral strictures, and describe a simple and reliable technique for harvest.

Materials and Methods

In 11 patients with refractory bulbar urethral strictures a nontubularized onlay patch of buccal mucosa was used for urethral reconstruction. All procedures were done with a 2-team approach in which 1 team (usually an oral surgeon and urologist) harvested the graft from the mouth, while the perineal team simultaneously exposed and calibrated the stricture.

Results

The length of buccal mucosa used ranged from 3.5 to 17 cm. (average 6.4). All patients achieved excellent results. No oral complications were noted, even in patients in whom multiple buccal mucosal grafts were obtained.

Conclusions

With the technique reported, buccal mucosa is a reliable, easily obtained tissue for patch graft urethroplasty. Our 2-team approach decreased operative time considerably.     

Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures

PURPOSE: We report the results of urethroplasty with a free graft of buccal mucosa as a dorsal onlay for the treatment of bulbar urethral strictures. MATERIALS AND METHODS: Since June 1994, 30 patients with bulbar urethral strictures have been treated with buccal mucosa urethroplasty. Urethroplasty was performed with a free graft of buccal mucosa using a ventral onlay in the first 7 patients and a dorsal onlay in 23. Dorsal urethrotomy was performed with a Sachse urethrotome after the bulbar urethra was separated from the corpora. The buccal mucosa onlay was sutured to the urethra and corpora cavernosa to ensure a patent urethra. RESULTS: At 20-month followup (range 3 to 50) the success rate was 96% (29 of 30 patients). Urethral stricture recurred in only 1 of 7 patients in the ventral onlay and none of 23 in the dorsal onlay group. CONCLUSIONS: Preliminary results of urethroplasty for bulbar urethral strictures with a dorsal onlay graft of buccal mucosa are excellent. Longer followup is needed to evaluate definitive results.     

Buccal mucosa graft urethroplasty for recurrent stricture of female urethra

Recurrent stricture of the female urethra is an uncommon, yet difficult, condition to manage. This report demonstrates a ventral buccal mucosa onlay graft technique as a feasible and reliable method of repairing this condition.     

Buccal mucosa urethroplasty in anterior urethral strictures

Buccal mucosal graft can be used for succesfull repair in both pendulous and bulbar strictures. MATERIAL AND METHODS: We present our experience with buccal mucosal graft repair in 8 patients with onlay patch that varies from 4 to 16 cm. in length. Three pendulous, two bulbar and three panurethral strictures were repaired. These patients were observed for 36 to 60 months. RESULTS: No stricture recurrences were observed. Only one patient had lower lip paresthesia for six months.     

Sclerosing Polycystic Adenosis of the Buccal Mucosa

Sclerosing polycystic adenosis (SPA) is a rare lesion of salivary glands with a striking resemblance to fibrocystic disease of the breast. Most of the 47 reported cases have occurred within the parotid gland, with only a single case being described within the buccal mucosa. We report an additional case of SPA of the buccal mucosa. The exact nature of this entity is unknown, but has up until recently believed to be a pseudoneoplastic reactive and inflammatory sclerosing process. Even though SPA has satisfied the criteria for monoclonality, the debate as to whether SPA represents a true neoplasm or a pseudoneoplastic inflammatory sclerosing process, with low-grade neoplastic potential continues. Awareness of the occurrence of this lesion in both major and minor salivary glands is important to promote its differentiation from other more sinister salivary gland pathology. Cure is effected by localized surgical excision and all reported cases of SPA show an excellent prognosis with no true recurrence or metastasis.     

A Review of Buccal Mucosa Graft Ureteroplasty

Purpose of Review

We review the buccal mucosa graft (BMG) ureteroplasty literature to evaluate its utility in the management of ureteral strictures, identify indications for which it is particularly useful, and highlight refinements in surgical technique.

Recent Findings

Recent reports have described the efficacy of robotic BMG ureteroplasty and the utilization of near-infrared fluorescence to assist with precise identification of the ureteral stricture margins.

Summary

BMG ureteroplasty is well-suited for ureteral reconstruction as it allows for minimal disruption of the delicate ureteral blood supply and facilitates a tension-free anastomosis. This technique is particularly useful in patients with long ureteral strictures not amenable to ureteroureterostomy and in patients with a recurrent ureteral stricture after a previously failed ureteral reconstruction.

     

Buccal mucosal urethroplasty: a versatile technique for all urethral segments

OBJECTIVE: To present our experience with buccal mucosa urethroplasty for substitution of all segments of the anterior urethra, as the buccal mucosal graft (BMG) has emerged as the tissue of choice for single-stage reconstruction of bulbar urethral strictures, but its use for reconstructing meatal, pendulous and pan-urethral strictures has not been widely reported. PATIENTS AND METHODS: Between January 1998 and October 2003, 92 patients had a BMG substitution urethroplasty at our institution; 75 had a single-stage dorsal onlay BMG urethroplasty (bulbar 41, pendulous 16 and pan-urethral 18; six combined penile skin flap and BMG) and 17 (pendulous five, pan-urethral 10, bulbar two) a two-stage urethroplasty. Recurrence rates, complications and cosmetic outcomes were analysed retrospectively. RESULTS: Over a median (range) follow-up of 34 (8-72) months, 66 (88%) patients with a one-stage reconstruction (14/16 pendulous; 37/41, 90%, bulbar; 15/16 pan-urethral) remained stricture-free. The mean (range) time to recurrence was 9.4 (3-17) months. Of the nine recurrent strictures, six were managed by one-stage optical urethrotomy and three required a repeat urethroplasty. In patients who had a staged procedure, after a mean follow-up of 24.2 (9-56) months, one had complete graft loss, requiring re-grafting, five required stomal revision after stage 1, and only two (12%) developed a recurrent stricture after the two-stage urethroplasty. CONCLUSION: A one-stage dorsal onlay BMG urethroplasty provides excellent results for strictures involving any segment of the anterior urethra. The BMG appears to be the most versatile urethral substitute, as it can be successfully used for both one- and two-stage reconstruction of the entire anterior urethra.