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。     

颊粘膜预制尿道分期治疗尿道下裂残废

目的：探讨运用颊粘膜移植预制尿道,分期治疗尿道下裂残废。方法：2001年至今,对76例尿道下裂残废患者采用Ⅰ期颊粘膜移植预制远端尿道,Ⅱ期局部皮瓣转移尿道吻接的方法进行手术治疗。结果：术后除一例尿道口狭窄外,其余病例的尿道均通畅,疗效满意。结论：颊粘膜移植分期尿道成形术是治疗尿道下裂残废的有效方法之一。     

颊粘膜移植修复尿道下裂的术后护理

目的 探讨应用颊粘膜移植加镍钛记忆合金尿道支架行一期尿道再造治疗尿道下裂的术后。 方法 对2004年10月至2006年10月33例应用颊粘膜移植加镍钛记忆合金尿道支架行尿道再造的尿道下裂患者的临床资料进行回顾性分析。术后进行细心的心理护理,密切观察术后不良反应并及时采取有效措施,加强术后康复护理。 结果 33例患者随访8月至18月,4例出现尿瘘、2例出现尿道狭窄,其中2例小尿瘘在经过保守治疗及护理下,于术后14～20天自行愈合。2例尿瘘及2例尿道狭窄分别在术后3个月及4个月再次手术成功。结论 应用颊粘膜移植加镍钛记忆合金尿道支架行尿道再造治疗尿道下裂,采取针对性且有效的术后护理措施,是手术成功的重要保证。     

利用背侧颊黏膜移植治疗女性尿道狭窄

最近的一些文献支持利用背侧颊黏膜移植的方法治疗女性尿道狭窄。 男性背侧颊黏膜移植疗法创始人Guido Barbagli和他意大利阿雷佐的同事在《美国泌尿外科杂志》2006年第10期上报道了一组接受移植背侧高嵌体颊黏膜的尿道成形术的女性患者。     

膀胱粘膜尿道成形术治疗复杂性尿道下裂

目的对膀胱粘膜尿道成形术治疗复杂性尿道下裂的适应证及手术方法进行讨论，以重新认识其应用价值。方法总结2002～2004年经多次手术失败的复杂性尿道下裂7例，平均尿道缺损5、7cm，采用改进后的膀胱粘膜尿道成形术Ⅰ划尿道成形的资料。结果术后均获得较为满意的疗效，阴茎伸直满意，外形好，尿线粗，开口近似正常位置。2例术后尿瘘，6个月后再次修补获成功，手术一次成功率71.4％。结论对多次手术失败、阴茎疤痕严重、局部取材困难、尿道缺损过长的复杂尿道下裂的病例，采用膀胱粘膜尿道成形术Ⅰ期尿道成形仍是目前合理、有效的手术方法。     

膀胱粘膜法一期尿道下裂修复术26例体会

对26例阴茎阴囊型、阴囊型先天性尿道下裂患行膀胱粘膜法一期尿道下裂修复术，全部病例排尿通畅，无尿瘘发生。此术式成功率高，外形效果良好。     

游离包皮在尿道下裂尿道成形术中的应用

1977—2003年我们对444例尿道下裂患儿行游离包皮尿道成形术，疗效较好，现报告如下。     

尿道板纵切卷管尿道成形在尿道下裂中的应用

目的：总结尿道板纵切卷管尿道成形术（Snodgrass法）治疗尿道下裂的经验，方法：对43例尿道下裂患儿行Snodgrass尿道成形术，其中阴茎体型35例，阴茎阴囊交界型8例，9例为上次尿道成形失败者；10例阴茎下弯者先行阴茎背侧折叠；患儿尿道置管10天，拔管后常规前尿道扩张，结果：43例随访4－11个月，阴茎外观正常，无下弯；尿道开口于阴茎头前端，呈纵行裂隙状，排尿通畅，无尿道狭窄，术后5例发生尿瘘，4例已做修补，均成功，结论：Snodgrass尿道成形术可应用于近，远端型及有阴茎下弯的尿道下裂患儿，对尿道成形失败而阴茎皮肤所剩极少者也是一种非常有效的方法。     

改良Mathieu手术在尿道下裂再次修复中的应用

目的:总结改良Mathieu手术在尿道下裂再次修复中的治疗经验。方法:应用改良Mathieu手术治疗尿道下裂失败病例24例。患儿年龄3¹2岁,平均4.5岁。20例为第2次手术,4例为第3次手术。其中大型的冠状沟尿瘘13例,尿道外口退缩5例,前段尿道崩裂6例。手术改良包括尿道后壁正中纵切、阴茎背侧血管神经束下方紧缩海绵体白膜、双层带血管蒂肉膜组织覆盖等技术。结果:24例中19例手术一次成功,阴茎伸直良好,外形美观,排尿正常,成功率79.2%(19/24)。尿瘘4例,1例自愈,3例行尿瘘修补痊愈。尿道外口狭窄1例,行尿道外口扩大整形治愈。无尿道狭窄及尿道憩室病例。术后行尿道镜检2例,未发现尿道后壁正中纵切处瘢痕增生。结论:改良Mathieu手术适用3种情况的尿道下裂失败病例,即大型的冠状沟尿瘘、尿道外口退缩和前段尿道崩裂。手术改良包括尿道后壁正中纵切、阴茎背侧血管神经束下方紧缩海绵体白膜、双层带血管蒂肉膜组织覆盖等技术。     

尿道板纵切卷管尿道成形术在尿道下裂术后尿道裂开中的应用

尿道裂开是发生于尿道下裂术后较严重的并发症，因多无可利用的包皮材料修补尿道，给再次手术带来困难。Snodgrass在1994年首先介绍了“尿道板纵切卷管尿道成形法”治疗尿道下裂的手术方法。我院近年开展用此方法治疗尿道下裂，并且从2001年1月～2002年12月应用尿道板纵切卷管尿道成形术(Snodgrass法)治疗尿道下裂术后尿道裂开患儿24例，效果良好，报告如下。     

Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations

AIM: To report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases. METHODS: From May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old (average 11.62 +/- 7.18 years) with failed previous hypospadias surgery were included in the present study. Indications included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corpora cavernosa. The neourethra was tubularized, and covered with subcutaneous (dartos) tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases. RESULTS: The buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months (mean 22.6 months), the total complication rate was 15.1%, with five cases of fistula and three cases of stricture. CONCLUSION: Inlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations.     

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.     

Tissue-engineered buccal mucosa for substitution urethroplasty

OBJECTIVE: To develop tissue-engineered buccal mucosa (TEBM) for use in substitution urethroplasty, as urethral reconstruction is limited by the amount and type of tissue that is available for grafting, and BM has become the favoured tissue for use as a urethral substitute in the last decade. MATERIALS AND METHODS: After enzymatic treatment of a small (0.5 cm) BM biopsy the epidermis and dermis were mechanically separated. Oral keratinocytes were isolated from the epidermis and oral fibroblasts from the dermis. These cells were expanded and applied to sterilized de-epidermized dermis (DED) to obtain a full-thickness TE oral mucosa. Horizontal migration of keratinocytes on the DED was assessed using a tetrazolium-blue (MTT) assay. The TEBM was assessed histologically after mechanical stressing in vitro using catheterization and meshing. RESULTS: Histologically the TEBM closely resembled the native oral mucosa after culturing at an air-liquid interface for 2 weeks. The MTT assay showed good horizontal migration of keratinocytes on the DED. Serial histology revealed a gradually increasing thickness of the epidermis and remodelling of the dermis by the fibroblasts from day 1 to day 14. Despite subjecting the TEBM to mechanical stress the integrity of the epidermal-dermal junction was maintained. CONCLUSIONS: We report the successful culture of full-thickness TEBM for substitution urethroplasty, which is robust and suitable for clinical use.     

Single-stage reconstruction of complex anterior urethral strictures using overlapping dorsal and ventral buccal mucosal grafts

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? This technique has been reported to have an excellent success rate in the bulbar urethra, although no data exists for its use in the penile urethra. This is the first study to report successful use of the technique in the reconstruction of penile urethral strictures.

OBJECTIVE

• ? To review our initial experience with single‐stage overlapping dorsal and ventral buccal mucosa graft (BMG) urethroplasty for the reconstruction of complex anterior urethral strictures.

PATIENTS AND METHODS

• ? Among 696 urethroplasties performed at two tertiary urethroplasty centres from October 2007 to September 2010, single‐stage urethral reconstruction using urethral plate incision and/or excision and overlapping dorsal and ventral BMGs was used in 36 men (5%) with complex urethral strictures (mean length 4.5 cm).
• ? Demographic and perioperative data was tabulated and outcomes were analysed.

RESULTS

• ? Stricture location was bulbar (61%), penile (19%), or both bulbar and penile (20%).
• ? Dorsal grafts, applied only within the most severely strictured segment, measured a mean 42% of the opposing ventral graft length.
• ? At a mean follow‐up of 15.7 months, 32 of the 36 cases were successful (89%).
• ? Repeat urethroplasty was performed in all four recurrences, three of which were successful at a mean follow‐up of 16 months.

CONCLUSION

• ? Single‐stage reconstruction of focally obliterative long urethral strictures using overlapping dorsal and ventral BMGs is safe and effective.