前段泌尿道狹窄在兩種尿道重建術之經驗-
單一醫學中心之經驗
曲元正、王大民、王敘涵、朱聖賢、陳孝文、江仰仁、劉冠麟、林國仁、林志德
林口長庚紀念醫院外科部 泌尿科系
Outcomes of urethroplasty for anterior urethral strictures:single-center experience
Yuan-Cheng Chu, Ta-Min Wang, Hsu-Han Wang, Sheng-Hsien Chu, Hsiao-Wen Chen, Yang-Jen Chiang, Kuan-Lin Liu, Kuo-Jen Lin, Chih-Te Lin
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou medical center, Taoyuan, Taiwan
Purpose:
Management of anterior urethral strictures is quite challenging due to high failure rates with many unavoidable postoperative complications. This study aims to elucidate the appropriate surgical techniques, advantages, and disadvantages of the different urethroplasties.
Materials and Methods:
We retrospectively recorded and analyzed 20 patients' demographics, surgical techniques, postoperative uroflowmetry, and complications. Patients were divided into two groups depending on the length of their stricture. Patients in Group 1 presented a urethral stricture or obliteration length of less than 3 cm and received excision and primary end-to-end anastomosed urethroplasty. Group 2 consisted of patients with a stricture or obliteration length of more than 3 cm who received buccal mucosa graft (BMG) augmented dorsal onlay urethroplasty. The success rate and objective parameters following anastomosed or augmented urethroplasties were assessed over an 8 year follow-up period.
Results:
Despite the longer strictures and different number of complete obliterations, BMG augmented urethroplasty exhibited comparable success rates (90%) with anastomosed urethroplasty (90%). The mean postoperative peak flow rates in the two groups were more than 15 mL/s, with Group 1 at 27.1 mL/s and Group 2 at 16.9 mL/s. No patients exhibited postoperative complications of incontinence or erectile dysfunction; no perineal wound infections were observed in any patient, and no significant complications were noted in the oral cavity where the buccal mucosa was harvested.
Conclusion:
Two conclusions were drawn from this clinical surgery experience. The first is that the type of urethral reconstruction should be considered according to the length of the urethral stricture. We suggest that urethral strictures longer than 3 cm are suitable for augmented urethral reconstruction. The second is that anatomical consideration of the urethra is also an important factor in choosing an appropriate urethroplasty. We recommend augmented urethral reconstruction for penile urethral strictures and anastomosed urethral reconstruction for bulbar urethral strictures.