腹侧口腔黏膜移植物尿道成形术

  • 介绍
  • 讲座
  • 论文
  • 常见问题与解答
  • 成果展示
  • 外科操作技巧
“皮肤或口腔黏膜移植尿道成形术”是在尿道狭窄处切开,以口腔黏膜移植物来增大尿道管径的手术。

图 1

图 2

图 3

图 4

通常有四种方式:

  • 腹侧口腔黏膜移植物尿道成形术。此术式中,移植物接合到尿道的腹侧(图1,2)。
  • 背侧口腔黏膜移植物尿道成形术。此术式中,移植物接合到尿道的背侧(图3,4)。
  • 侧向口腔黏膜移植物尿道成形术。此术式中,移植物接合到尿道的外侧。
  • 完全口腔黏膜移植物尿道成形术。此术式中,移植物完全代替狭窄的尿道。

 

本术式适用于不存在损伤性尿道球部狭窄,且狭窄长度大于2cm。

论文 1

Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M.
Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique?
J Urol. 2005 Sep;174(3):955-7

Purpose: The use of buccal mucosa graft onlay urethroplasty represents the most widespread method of bulbar urethral stricture repair. The graft may be placed on the ventral or dorsal urethral surface according to surgeon experience and preference. We investigated whether the results are affected by the surgical technique by comparing the outcome of 3 types of bulbar urethroplasty using buccal mucosa graft.
Material and Methods: We repaired 50 bulbar urethral strictures with buccal mucosa grafts from 1997 to 2002. Mean patient age was 42 years. The etiology of stricture was ischemia in 12 cases, trauma in 6, instrumentation in 4 and unknown in 28. Patients with lichen sclerosus, failed hypospadias or urethroplasty and stricture extending into the penile urethra were not included. A total of 47 patients (94%) had undergone previous urethrotomy or dilation. The buccal mucosa graft was always harvested from the cheek using a 2 team approach. Mean graft length was 4.2 cm. The graft was placed on the ventral, dorsal and lateral bulbar urethral surface in 17, 27 and 6 cases, respectively. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean followup was 42 months (range 12 to 76).
Results: Of 50 cases 42 (84%) were successful and 8 (16%) failed. The 17 ventral grafts provided success in 14 cases (83%) and failure in 3 (17%). The 27 dorsal grafts provided success in 23 cases (85%) and failure in 4 (15%). The 6 lateral grafts provided success in 5 cases (83%) and failure in 1 (17%). No surgical complications were observed. Failures involved the anastomotic site (distal in 2 and proximal in 3) and the whole grafted area in 3 cases. They were treated with urethrotomy in 5 cases and 2-stage urethroplasty in 3.
Conclusions: In our experience the placement of buccal mucosa grafts into the ventral, dorsal or lateral surface of the bulbar urethra showed the same success rates (83% to 85%) and the outcome was not affected by the surgical technique. Moreover, stricture recurrence was uniformly distributed in all patients.

论文 2
Barbagli G., Guazzoni G., Lazzeri M.
One-Stage bulbar urethroplasty: Retrospective analisys of the results in 375 patients
Eur Urol 2008; 53:828-33

Objective: To review the outcome of bulbar urethroplasty using one-stage surgical techniques.
Methods: Of 375 patients, who underwent one-stage bulbar urethroplasties, 165 patients (44%) underwent anastomotic repair (AR), 40 (10.7%) underwent augmented anastomotic repair (AAR) using penile skin grafts (PSGs) or oral mucosal grafts (OMGs), and 170 (45.3%) underwent onlay grafting techniques (OGTs) using PSGs or OMGs. Clinical outcome was considered a failure when any postoperative instrumentation was needed. The chi(2) and Fisher’s exact test for categorical data were used. The sample size of 375 patients provides a statistical power (1-beta) of 99% at alpha=0.05; p<0.05 was set as significant.
Results: The average follow-up was 53 mo. Of 375 cases, 313 (83.5%) were successful and 62 (16.5%) failures. Of 165 ARs, 150 (90.9%) were successful and 15 (9.1%) failures. Of 40 AARs, 24 (60%) were successful and 16 (40%) failures. Of 170 OGTs, 139 (81.8%) were successful and 31 (18.2%) failures. The AR showed statistically significant higher success rate compared to OGT (p=0.023) and AAR (p=0.0001). Of 47 PSGs, 28 (59.6%) were successful and 19 (40.4%) failures. Of 163 OMGs, 135 (82.8%) were successful and 28 (17.2%) failures. This difference was statistically significant (p=0.002).
Conclusions: One-stage bulbar urethroplasties showed an overall 83.5% success rate. The AR showed the higher success rate compared to the OGT or AAR. OMGs (82.8% success rate) perform statistically better than PSGs (59.6% success rate).

论文 3
Guido Barbagli , Salvatore Sansalone , Giuseppe Romano and Massimo Lazzeri
Ventral onlay oral mucosal graft bulbar urethroplasty
BJU Int 2011; 108: 1218-1231

The current surgical approach to the uncomplicated bulbar urethral stricture began in 1993 when El-Kasaby et al . described the repair of anterior urethral strictures using an oral mucosa graft, including eight patients who underwent bulbar urethroplasty. In 1996, Morey and McAninch first described ventral onlay oral mucosa urethroplasty, suggesting suturing of the oral graft in the ventral surface of the urethra. In 1996, Barbagli et al . described the dorsal free-graft urethroplasty, suggesting suturing the graft in the dorsal surface of the urethra, over the albuginea of the underlying corpora cavernosa. The location of the graft on the ventral or dorsal urethral surface has become a contentious issue, dating from the time these two techniques were described. Success with bulbar oral mucosal grafts has been high with dorsal or ventral graft location and the different graft positions have shown no differences in success rates. Recently, we developed a new muscle and nerve-sparing bulbar urethroplasty, avoiding fully opening the bulbo-spongiosum muscle, thus better preserving ejaculatory function. The selection of a surgical technique for bulbar urethra reconstruction, in addition to respecting the status of the genitalia tissue and components, must also be based on the proper anatomical characteristics of the bulbar urethra, to ensure graft take and survival. Further, sexual function can be placed at risk by any surgery on the genitalia, and dissection must avoid interference with the neurovascular supply to the penis and genitalia. Bulbar urethroplasty using grafts should not compromise penile length or cause penile chordee, and certainly should not untowardly affect penile and genitalia appearance.
1. 问: 手术费是否可以由国家保健系统(意大利)全额负担?
答: 是的。


2. 问: 此项手术使用什么麻醉方式?
答: 经鼻的全身麻醉。


3. 问: 手术时间多长?
答: 约2小时。


4. 问: 手术后是否有勃起、生育问题或者尿失禁的风险?
答: 没有。


5. 问: 手术后住院时间是多长?
答: 一般来讲,5到7天


6. 问: 术后多长时间可以拔除尿管?
答: 至少保留至术后4周,待术后首次尿路造影结果正常后拔除。


7. 问: 恢复期有什么特别需要注意的问题么?
答: 在恢复期,抗生素的使用一般持续到尿管拔除以后。同时,长途坐车旅行,重体力劳动、性生活以及运动是暂时需要避免的。


8. 问: 术后什么时候可以恢复工作、性生活以及运动?
答: 在拔除尿管的一个月后,根据情况逐步恢复即可。


9. 问: 手术以后是否可以立即骑自行车或摩托车?
答: 不建议术后立即进行骑车、骑马等运动。


10. 问: 术后饮食需要注意些什么?
答: 避免啤酒以及烈性酒精饮品,巧克力,可可,坚果和贝类不要多吃。