經由40例尿道狹窄的重建手術所獲得的經驗
王大民、江仰仁、陳孝文、朱聖賢、劉冠麟、王敘涵、林國仁
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 40 URETHROPLASTIES FOR URETHRAL STRICTURES
Ta-Min Wang, Yang-Jen Chiang, Hsiao-Wen Chen, Sheng-Hsien Chu, Kuan-Lin Liu,
Hsu-Han Wang, Kou-Jen 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 8-year experience with open urethroplasty for treatment of urethral strictures
Materials and Methods: From 2007 through 2015, 40 patients (mean age 36.6 years) underwent open urethroplasty for urethral reconstruction. Twenty-seven patients had posterior urethral stricture and 13 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 was 2.69±0.97 cm (rang 1.5 to 5.5 cm). Excision and primary anastomosis (EPA) for 4 anterior urethral strictures and buccal mucosa graft augmented urethroplasty for 9 anterior urethral strictures were performed. Transperineal bulbo-membranous anastomosis was performed for 27 posterior urethral strictures.
Results: The results were successful in 23 (85%) cases of posterior urethral stricture and 13 (100%) 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 three cases. The mean peak flow rate at the last follow-up visit was 18.1±6.5 ml/s. Four patients developed recurrent urethral strictures. The negative results were related to incomplete excision of fibrotic posterior urethra in 2 cases, an anastomotic tension due to long distraction defect in 2 cases.
Conclusions: From our limited 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.