使用口腔黏膜移植於十五公分段落之尿道狹窄重建-困難案例報告

董牧喬¹、余燦榮¹

¹義大醫院泌尿科

Fifteen-centimeter-long Penile Urethral Stricture Rescued by Buccal Mucosa Graft Urethroplasty- A Rare Case Report

Mu-Chiao Tung、Tsan-Jung Yu

Department of Urology, E-DA Hospital, Kaohsiung, Taiwan

Summary:

We are presenting a rare case of 15-centimeter-long urethral stricture that was rescued by buccal mucosa graft urethroplasty.

In February of 2019, a 21-year-old male visited our urology department with chief complaint of urinary difficulty, weak urinary stream with bifurcation, and off and on dysuria for years. According to his statement, he had been diagnosed of urethra stricture at local clinic since he could remember. His initial uroflowmetry at our hospital showed low-plateau shape with voided volume 203ml, Qmax: 6 ml/sec, and post voiding residual volume 58ml. Thickened bladder wall was also found under bladder echogram. Furthermore, a18Fr. Fiberocystoscope could not entered the urethra before urethral sounding from six Fr to 20 Fr. Fibrotic penile urethra mucosa from penile urethra to bulbomembranous urethra was discovered while his prostate urethra was intact. Since then, he had received more than 30 sessions of urethral sounding and two times of optical internal urethrotomy surgery along with months of Foley catheterization within two years. However, these procedures had failed to treat his lower urinary tract symptoms and urethral stricture.

After discussion with patient and his family, they agreed to buccal mucosa graft urethroplasty in July, 2021. The ventral urethra slit length was about 15cm and was patched with previously harvested buccal mucosa graft 15x 1cm in size. A 18 Fr Silicon Foley catheter was placed and taken home after discharge. Complication of urethrocutaneous fistula had occurred. Fistula repair with simple primary suture was performed in March, 2022. Post-operative uroflowmetry showed bell shape, voided volume 215ml, Qmax: 32 ml/sec, and post voiding residual volume 35ml. Patient was very satisfied after the whole course of treatment.

So far, we had performed four cases of buccal mucosa graft urethroplasty for urethral stricture. All of them had good outcome while this was the most difficult case with its long stricture length. We genuinely recommend this procedure to patient with refractory urethral stricture.