分两期完成的尿道成形术

  • 介绍
  • 讲座
  • 论文
  • 常见问题与解答
  • 成果展示
  • 外科操作技巧

“分两期完成的尿道成形术”，即在不同时间，分2此完成尿道修复。

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图 1
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图 2
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图 3
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图 4

首次手术进行尿道切开和会阴部造口（图1）。 (会阴部尿道造口术)
一年后，闭合会阴部尿道造口（图2,3,4），患者从原尿道外口排尿。
此种手术适合伴有复杂尿路狭窄的患者。

讲座 1:

Uretroplastia en dos tiempos ¿cómo y cuándo ?
51 Curso de Urologia Fundació Puigevert
18 – 20 de octubre 2006
Barcelona – Spain
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讲座 2:
Penile and bulbar urethroplasty Surgical techniques and results
Hong Kong Urological Association Urethroplasty Workshop Division of Urology – Tuen Mun Hospital
Hong Kong
February 9 – 10, 2009
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论文 1
Barbagli G, Palminteri E, Bartoletti R, Selli C, Rizzo M.
Long-term results of anterior and posterior urethroplasty with actuarial evaluation of the success rates.
J Urol. 1997 Oct;158(4):1380-2.

Purpose: We analyzed the long-term results of different urethroplasty techniques.
Materials and Methods: We performed a retrospective review of 98 patients who underwent different procedures for anterior (78) and posterior (20) urethral strictures. Mean followup was 53 months. A total of 20 patients underwent end-to-end anastomosis (group 1), 30 underwent 1-stage procedures (group 2), 28 underwent 2-stage procedures (group 3), and 20 underwent bulboprostatic anastomosis (group 4). The results were analyzed using Kaplan-Meier curves and log rank test.
Results: The success rate was 95% for group 1, 93.4% for group 2, 78.6% for group 3, and 70% for group 4. Statistical evaluation of the actuarial success rates failed to show significant differences among the 4 groups.
Conclusions: The stricture recurrences were uniformly distributed over time. Urethroplasty patients must be followed for the rest of their lives.
论文 2
Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D.
Long-term outcome of urethroplasty after failed urethrotomy versus primary repair.
J Urol. 2001 Jun;165(6 Pt 1):1918-9

Purpose: A urethral stricture recurring after repeat urethrotomy challenges even a skilled urologist. To address the question of whether to repeat urethrotomy or perform open reconstructive surgery, we retrospectively review a series of 93 patients comparing those who underwent primary repair versus those who had undergone urethrotomy and underwent secondary treatment.
Materials and Methods: From 1975 to 1998, 93 males between age 13 and 78 years (mean 39) underwent surgical treatment for bulbar urethral stricture. In 46 (49%) of the patients urethroplasty was performed as primary repair, and in 47 (51%) after previously failed urethrotomy. The strictures were localized in the bulbous urethra without involvement of penile or membranous tracts. The etiology was ischemic in 37 patients, traumatic in 23, unknown in 17 and inflammatory in 16. To simplify evaluation of the results, the clinical outcome was considered either a success or a failure at the time any postoperative procedure was needed, including dilation.
Results: In our 93 patients primary urethroplasty had a final success rate of 85%, and after failed urethrotomy 87%. Previously failed urethrotomy did not influence the long-term outcome of urethroplasty. The long-term results of different urethroplasty techniques had a final success rate ranging from 77% to 96%.
Conclusions: We conclude that failed urethrotomy does not condition the long-term result of surgical repair. With extended followup, the success rate of urethroplasty decreases with time but it is in fact still higher than that of urethrotomy.
论文 3
Palminteri E, Lazzeri M, Guazzoni G, Turini D, Barbagli G.
New 2-stage buccal mucosal graft urethroplasty.
J Urol. 2002 Jan;167(1):130-2

Purpose: Previously buccal mucosal grafts used for repairing adult bulbourethral stricture with the 1-stage dorsal technique has provided a satisfactory outcome in our experience. We present the wider use of buccal mucosal grafts for 2-stage urethroplasty.
Materials and Methods: A total of 24 men 25 to 60 years old (median age 45) with a complex bulbar stricture underwent 2-stage urethroplasty using a buccal mucosal graft to repair the perineostomy. The primary etiology of stricture was traumatic in 4 cases, inflammatory in 16 and unknown in 4. The 2 x 6 cm. graft was harvested from the inner cheek and sutured to the left margin of the urethral mucosal plate with running 6-zero polyglactin suture. Patients were discharged from the hospital within 3 days with a 14Fr silicone urethral catheter in place. Radiological studies and urethroscopy were done 1 year after closure.
Results: A final successful outcome with no recurrent stricture was achieved in 23 of 24 men (92.8%) at a median followup of 18 months (range 13 to 32). In 1 case a urethrocutaneous fistula at the initial radiological assessment closed spontaneously after 14 days of catheterization. No urethral diverticula developed. The mean postoperative peak flow rate is 22 ml. per second (range 18 to 25).
Conclusions: Our new 2-stage buccal mucosal graft urethroplasty may be an excellent technique for complex bulbar urethral stricture disease. Our suggestions may increase usefulness of the 2-stage technique for repairing complex strictures due to the avoidance of classic complications.
论文 4
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).
1. 问: 此项手术使用什么麻醉方式？
答: 经鼻或经口气管插管的全身麻醉。

2. 问: 手术时间多长？
答: 首次手术约2小时，第二次手术大约1小时。

3. 问: 手术后是否有勃起、生育问题或者尿失禁的风险？
答: 没有。

4. 问: 手术后住院时间是多长？
答: 一般来讲，5到7天

5. 问: 术后多长时间可以拔除尿管？
答: 首次手术后至少保留至术后2周。第二次手术后需留置一个月，直到术后尿路造影检查正常方可。

6. 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。

7. 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。

8. 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。

9. 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。