前尿道内支架管在治疗前尿道狭窄中的应用

目的:观察在前尿道狭窄患者中留置前尿道支架管的临床疗效。方法:选取2005年1月至2008年5月在本院住院治疗及进行门诊尿道扩张的患者共38例作为治疗组,并将同期在本院采取尿道扩张器扩张的患者38例纳入对照组,通过最大尿流率(Qmax)及扩张次数等指标对两组的临床疗效进行对比分析。结果:尿流率检测表明留置支架管后所有患者的Qmax均较术前明显增加,对拔管后6个月随访结果进行分析,治疗组Qmax>15ml/s的患者显著多于对照组(P<0.05)。结论:采用前尿道内留置支架管治疗前尿道狭窄不但显著减少扩张次数,减轻患者的经济负担,也显著改善患者的生活质量,前尿道狭窄患者中留置前尿道内支架管不失为临床上一种较好的治疗手段,并取得了良好的预期效果,简单易行,效果确切,值得推广。     

Tunica albuginea urethroplasty for anterior urethral strictures: A urethroscopic analysis

Objective:   To assess the efficacy of tunica albuginea urethroplasty (TAU) for anterior urethral strictures.
Methods:   We assessed 206 patients with anterior urethral strictures who underwent TAU. The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove with a silicon catheter in situ . Thus in neourethra, the roof is formed by tunica albuginea of the urethral groove. Results were assessed at 6, 12, 24 and 36 months by comparative analysis of patient satisfaction along with retrograde urethrogram, urethrosonogram, uroflowmetry, and were categorized as good, fair and poor. Good and fair results were considered as successful. Thirty patients were taken for postoperative urethroscopic analysis to allow better understanding of both successful and failed cases.
Results:   Postoperative evaluation at 6 months showed a 96.6% success rate, which decreased to 94.7% at 1 year, 93.2% at 2 years and over 90% at the end of 3 years. The overall failure rate was 9.2%, which required revision surgery. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra uniformly lined by urothelium over roof formed by tunica albuginea of the corpora cavernosa in successful cases. Failure cases showed diffuse fibrotic narrowing or circumferential scarring.
Conclusion:   Tunica albuginea is a locally available distensible tissue, sufficient to maintain the patency of the neourethra, without any graft or flap. TAU is easier and useful when patients have unhealthy oral mucosa due to tobacco chewing.     

Urethroplasty for refractory anterior urethral stricture.

PURPOSE: We present our results managing anterior urethral strictures previously treated with urethroplasty and/or urethrotomy. MATERIALS AND METHODS: During a 32-month period 69 males 10 to 76 years old (mean age 36) underwent treatment for anterior urethral stricture, including 32 (46%) and 26 (38%) previously treated with urethroplasty and urethrotomy, respectively. In 11 patients (16%) no previous procedures had been done. Anastomotic and dorsal patch urethroplasty was performed for bulbar stricture in 13 and 14 cases, respectively, while in 4 a penile skin flap was placed for penile stricture and in 38 a 2-stage procedure was done with urethral substitution using buccal mucosa or post-auricular skin grafts. Patients were followed with ascending urethrography at 3 weeks, and 12 and 18 months as well as with uroflowmetry. Symptoms were assessed for 6 months to 4 years. RESULTS: Only 1 stricture recurred in patients treated with anastomotic or patch urethroplasty, or a skin flap. Of the patients scheduled for a 2-stage procedure stage 1 revision was required due to graft scarring or stenosis at the urethrostomy site in 21% and stage 2 revision was required in 23%. Other complications in this series included fistula in 3% of cases, wound infection in 3% and post-void dribbling in 12%. CONCLUSIONS: Overall early results are good in our urethroplasty series in patients with a previously instrumented urethra. Patients should be advised of the possible need for multiple revisions of planned staged procedures. The increased rate of revision in these staged procedures compared with the excellent outcome of 1-stage procedures appears to be inherent in this operation in patients with multiple previous procedures rather than due to surgeon experience.     

Sonographic staging of anterior urethral strictures

PURPOSE: Although radiographic retrograde urethrography has traditionally been the gold standard for imaging the anterior urethra, sonourethrography has proved to be precise and effective for evaluating urethral strictures. We review the evolution of sonourethrography and demonstrate its practical contemporary applications. MATERIALS AND METHODS: We performed literature reviews on MEDLINE and chart reviews of our patient records from 1988 to 1998. RESULTS: Sonourethrography measures stricture length in the bulbar urethra more accurately than conventional retrograde urethrography. Spongiofibrosis is manifested sonographically by a lack of urethral distensibility during retrograde instillation of saline solution. Posterior shadowing is noted in severe posttraumatic cases. Sonographic staging before treatment of complex or reoperative anterior strictures elucidates complicating features, such as calculi, urethral hair, false passage and stent encrustation. CONCLUSIONS: Sonographic staging of anterior urethral strictures offers clinically important information that may be useful in guiding reconstructive therapy.     

Excision and primary anastomosis for anterior urethral stricture

Excision with spatulated primary anastomosis (EPA) is an excellent reconstructive option for short bulbar urethral strictures with success rates between 90 and 95% in appropriately selected patients. Patient selection requires a careful history, physical examination, and radiographic staging. Failure with this reliable method is caused by inadequate excision of urethral stricture and incomplete mobilization of the urethra with excessive anastomotic tension. Complications that include wound and urinary tract infections, chordee, and erectile dysfunction, are uncommon. EPA warrants strong consideration as a first line treatment due to its excellent and durable long-term results.     

窥镜直视下尿道内切开术加电切术治疗尿道狭窄

目的：探讨尿道狭窄的有效治疗方法。方法：对1991—2000年收治的128例尿道狭窄患者的临床资料进行回顾性分析，并比较窥镜直视下尿道内切开术和直视下尿道内切开术加电切术的疗效。结果：作单纯直视下尿道内切开术56例，治愈29例(51．9％)。作窥镜直视下尿道内切开术加电切术72例，治愈63例(87．5％)。结论：窥镜直视下尿道内切开术加电切术的方法可明显提高尿道狭窄的疗效，减少其复发率。     

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.     

前尿道狭窄的病因和治疗

前尿道狭窄的发生率有增高趋势,如治疗不当,会进一步加重尿道损伤而造成复杂性前尿道狭窄,难于处理。近年来在其治疗上取得了很大进步,但多数泌尿外科医师对此病认识不足,治疗上存在差异,可能导致并发症的发生。     

Full thickness skin graft urethroplasty for anterior urethral strictures.

Thirty-two free full thickness skin graft urethroplasties were performed over a thirty-nine-month period. Follow-up of more than six months was available in 27 patients. Results were good or fair in 26 patients (96 per cent). Only 1 patient has been classified as a failure and required reoperation.     

Urethroplasty for anterior urethral strictures in a community-based urology practice

Introduction The outcome of urethroplasty for the anterior urethral stricture is superior to internal urethrotomy. However, the excellent results are often reported by tertiary medical centres and most urologists in general urological practice do not offer urethroplasty. We review the results of our institution to ascertain whether equivalent results are achievable in a district hospital urology service. Methods Over a 22-month period, 26 urethroplasties were performed. Mean age was 44.2 years (range: 16–83 years) and median follow-up was 14.6 months (range: 0.6–40.2 months). Anastomotic repair was performed in five, substitution urethroplasty in 15 (nine flaps and six grafts) and␣staged urethroplasty in 6. Length of strictures ranged from less than 0.2 cm to greater than 10 cm. Results Stricture-free rate of 90.5% at 1 year was observed. Only two cases developed repeat stricture formation. Other minor complications included one epididymo-orchitis and one haematoma. Conclusion Good early outcome for urethroplasty for anterior urethral strictures is achievable in a district hospital practice. Keys to good outcome include having a dedicated team and a wide repertoire of urethral reconstructive techniques.     

Long-term followup for excision and primary anastomosis for anterior urethral strictures

PURPOSE: We report our experience and long-term followup of patients undergoing excision and primary anastomotic reconstruction for anterior urethral strictures. MATERIALS AND METHODS: From July 1986 to May 2006 the charts of 260 patients who underwent excision with primary anastomosis at our center for bulbar urethral stricture were reviewed. Patient age ranged from 14 to 78 years (mean 38.4), stricture length ranged 0.5 to 4.5 cm (mean 1.9). Patients who had surgery within the last 5 years were contacted by telephone if their 6-month postoperative cystoscopic evaluation was patent and they had not visited the clinic afterward. RESULTS: After a mean followup of 50.2 months 257 patients (98.8%) were symptom-free and required no further procedures. Recurrent stricture occurred early in 2 patients and late in 1 patient. Two patients opted for intermittent dilations, and a single direct visual internal urethrotomy was performed in 1 patient 4 years postoperatively. One of the patients who elected dilation subsequently elected urethral reconstruction, which was done successfully. Complications encountered were position related neuropraxia in 9 (3.4%), early urinary tract infection in 13 (5%), chest related in 5 (1.9%), scrotalgia in 4 (1.5%) and wound related in 4 (1.5%). All resolved within the early postoperative period. Erectile dysfunction was encountered in 6 (2.3%) patients, of whom 4 had a history of significant straddle trauma, 4 responded well to oral pharmacotherapy and 1 elected to not have the erectile dysfunction treated. CONCLUSIONS: Excision with primary anastomosis for anterior urethral stricture has a high success rate of 98.8% with durable long-term results in most patients. Complications are few, of short duration and self-limited. Where applicable, we believe that the procedure clearly is the choice for short anterior urethral strictures.     

尿道背侧颊黏膜镶嵌补片法治疗长段前尿道狭窄

目的 评价颊黏膜尿道背侧镶嵌技术尿道修复重建手术的有效性和安全性.方法 男性前尿道狭窄患者57例.平均年龄36(17～52)岁.尿道狭窄长度平均3.0(2.5～7.0)cm.颊黏膜取材长度平均4.0(3.5～8.0)cm,平均宽度2.3(I.8～2.5)am.57例均有经尿道内窥镜冷切电切手术史,其中1次手术史29例(51%),2次20例(35%),3次8例(14%),行耻骨上膀胱造瘘48例,9例采用尿道扩张维持.手术游离并旋转尿道,并于尿道背侧纵行切开,6-0可吸收线缝合颊黏膜与尿道切缘.保留尿管4周,拔管时行顺行尿道造影.患者排尿困难和尿线变细、尿道造影或尿道镜发现尿道管腔狭窄<16 F确定为尿道狭窄复发.结果 57例手术均成功,平均手术时间135(105150)min.平均随访11.2(1～23)个月.尿道通畅54例(95%),术后2～3个月复发3例(5%),狭窄部位均为远端的颊黏膜与尿道结合部,行尿道内窥镜冷刀切开,定期尿道扩张治疗.伤口感染3例,未发生尿瘘及尿道憩室.患者口腔疼痛持续2～5 d,平均2.3 d.术后无张VI困难、颊部麻木及腮腺导管梗阻等并发症发生,VI腔颊部均未见瘢痕形成.结论 VI腔颊黏膜尿道背侧镶嵌补片修复重建尿道,效果确切、并发症少、狭窄复发率低,是理想的长段前尿道狭窄的修复重建手段.     

Apparent congenital anterior urethral stricture in brothers.

Anterior urethral strictures of apparent congenital origin are reported in brothers and the literature is reviewed.