經由101例尿道狹窄的重建手術所獲得的經驗

王大民、陳思遠、王敘涵、林國仁、林志德、潘伯諺、林晏頎

林口長庚紀念醫院 長庚大學 外科部 一般泌尿及腎臟移植科

LESSONS LEARNED FROM 101 URETHROPLASTIES FOR URETHRAL STRICTURES

Ta-Min Wang, Sy-Yuan Chen, Hsu-Han Wang, Kou-Jen Lin, Chih-Te Lin, Pai-Yen Pan, Yen-Chi Lin

Division of General Urology and Renal Transplantation, Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

Purpose: To report our 17-year experience with open urethroplasties for treatment of urethral strictures.

Materials and Methods: From 2007 through 2024, 101 patients (mean age 36.6 years) underwent open urethroplasty for urethral reconstruction. Fifty-nine patients had posterior urethral stenosis and 42 had anterior urethral stricture. Preoperative evaluation of the urethral stricture included a simultaneous retrograde urethrogram and/or cystogram. The mean estimated preoperative real length of the urethral disruption or obliteration for posterior urethral stenosis was 2.69±0.97 cm (rang 1.5 to 5.5 cm). Excision and primary anastomosis (EPA) for 21 anterior urethral strictures and buccal mucosa graft augmented urethroplasty for 21 anterior urethral strictures were performed. Transperineal bulbo-membranous anastomosis was performed for 59 posterior urethral distraction defects.

Results: The results were successful in 49 (83%) cases of posterior urethral stricture and 41 (97.6%) cases of anterior urethral stricture. Post-operative evaluation included voiding cystourethrography, urethroscopy, and uroflow study. Voiding cystourethrography performed postoperatively demonstrated a wide, patent anastomosis in all but 11 cases. The mean peak flow rate at the last follow-up visit was 18.1±6.5 ml/s. Eleven patients developed recurrent urethral strictures. The negative results were related to incomplete excision of fibrotic posterior urethra in 4 cases, an anastomotic tension due to long distraction defect in 7 cases.

Conclusions: From our experience, buccal mucosa graft augmented urethroplasty and EPA are reliable methods in management of anterior urethral stricture. The essential operative techniques of posterior urethroplasty included complete excision of scar tissue involving the membranous urethral region, and creation of tension free mucosa to mucosa repair.