創傷性尿道狹窄施行口腔黏膜尿道重建手術之案例回顧
瞿琤1、林志杰1,2、黃志賢1,2
1臺北榮民總醫院 泌尿部；2國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心
One-stage buccal mucosal urethroplasty for traumatic anterior urethral stricture: a single- center retrospective cohort analysis
Cheng Chu1, Chih-Chieh Lin1,2, William J. Huang1,2
1Department of Urology, Taipei Veterans General Hospital
Department of Urology, School of Medicine and Shu-Tien Urological Research Center,
2National Yang Ming Chiao Tung University, Taipei, Taiwan
Purpose:
Management of partial or complete traumatic urethral disruption of the anterior urethra poses a challenge. Buccal mucosal grafts(BMG) are the gold standard for substitution urethroplasty. Here, we evaluate the efficacy and complications arising from one-stage BMG with dorsal onlay augmented anastomotic technique for traumatic anterior urethral stricture, examine early surveillance urethroscopy and long term outcomes among urethroplasty patients.
Materials and Methods:
From January 2015 to July 2022, male patients with anterior urethral stricture ≥ 2 cm were retrospectively analyzed. All patients underwent one-stage BMG dorsal onlay anastomotic technique by a single surgeon. Preoperative suprapubic catheterization was initially carried out in all patients. Their ages ranged from 18 to 63 years (mean of 42.5 years). Post-operative evaluations including uroflowmetry and early surveillance findings with using a flexible 16.5 Fr cystoscope. The primary outcome was the stricture free survival rate, defined as no stricture recurrence.
Results:
A total of 12 patients with pinhole or blind end anterior urethral stricture were included. The stricture site was bulbar in 4, pendulous in 7 and pan-urethral in 1; the mean (range) stricture length was 4.3 (2-6) cm. The mean follow-up period was 15 months (range 4-24). The median maximum urination rate was 4.5 ml/s. Following the anterior urethroplasty, we examine the stricture site with using flexible cystosocpe in every 2 weeks and all the patients still had annular stricture in post-operative first month. Two patients had complication with previous
buccal mucosa flap grew well but the size shrinkage, then one patient re-do BMG urethroplasty in post-operative first month, another patient re-do in post-operative 3rd month. In our cohort, the post-operative annular stricture could be reconstructed by using the solid sound in every month. The stricture free survival rate was 80% (8/10) after solid sound reconstruction for 12 months.
Conclusion:
Early flexible cystoscopic visualization of the urethroplasty site is a feasible and reliable examination for following post-operative status. Even in difficult cases with traumatic urethral pinhole or blind end anterior urethral stricture, the results of one-stage BMG urethroplasty with the combined solid sound reconstruction demonstrate a decrease in the frequency of recurrence of urethral stricture.