舌黏膜与颊黏膜或包皮拼接重建尿道治疗长段尿道狭窄

目的 探讨舌黏膜与颊黏膜或包皮拼接尿道成形治疗多节段或长段尿道狭窄的安全性和治疗效果.方法 尿道狭窄患者11例,年龄24～56岁,平均32岁.其中前尿道长段狭窄7例,狭窄长度10～15 cm,平均12 cm;尿道2～3处狭窄4例.病程6个月～8年.取舌黏膜条与颊黏膜条拼接尿道成形治疗7例,舌黏膜条与包皮瓣拼接尿道成形治疗4例.结果 11例手术顺利.1例舌黏膜与包皮拼接尿道成形患者术后3个月并发尿道外口狭窄,经手术矫正后排尿通畅,术后8个月最大尿流率27.5 ml/s.余10例排尿通畅、尿线粗,术后随访5～12个月,平均10个月,最大尿流率21～36 ml/s,平均26.8 ml/s.结论 舌黏膜与颊黏膜或包皮拼接尿道成形具有取材方便、患者创伤小的特占点,是治疗长段尿道律窄的较好术式.尤其适用于尿道多处狭窄者.     

口腔内黏膜尿道成形治疗前尿道狭窄10年经验总结

目的 探讨口腔内黏膜尿道成形治疗尿道狭窄的长期效果. 方法 2001年1月至2010年12月,应用口腔内黏膜(颊黏膜和舌黏膜)尿道成形治疗前尿道狭窄255例.尿道狭窄段长度3 ～18 cm,平均6 cm.尿道成形采用保留原尿道板的扩大尿道成形术或埋藏黏膜条背侧替代尿道成形术.对49例尿道狭窄段≥8 cm者采取双侧颊黏膜拼接、颊粘膜与舌黏膜拼接或双侧连续长条舌黏膜尿道成形. 结果 术后随访8 ～120个月,平均37个月.230例患者排尿通畅,尿线粗,最大尿流率为16～51 ml/s,平均26 ml/s.尿道造影显示重建段尿道管腔通畅.总成功率90.2％.25例患者于术后1年内发生并发症,其中尿道再次狭窄17例,尿道皮肤瘘8例.17例尿道再狭窄患者中15例再次行口腔内黏膜尿道成形,2例吻合口狭窄行尿道内切开,术后排尿通畅;8例尿道皮肤瘘均接受尿瘘修补术后治愈. 结论 口腔颊黏膜和舌黏膜均是良好的尿道替代物,舌黏膜取材较颊黏膜更为便利;口腔内多种黏膜的组合移植重建尿道是治疗长段前尿道狭窄( ≥8 cm)的有效方法.     

舌黏膜尿道成形治疗前尿道狭窄（附80例报告）

目的：研究舌黏膜尿道成形治疗尿道狭窄的有效性和安全性。方法：2006年8月～2008年12月采用舌黏膜尿道成形治疗80例前尿道狭窄,尿道狭窄段2．5～18cm,其中30例为长段尿道狭窄（9～18cm）采用双侧舌黏膜或舌黏膜与颊黏膜或与带蒂包皮拼接尿道成形治疗。尿道成形采用两种术式：保留原尿道板的扩大尿道腔37例;埋藏黏膜条43例。结果：术后随访4～30（平均16．8）个月,7例发生并发症,其中尿瘘4例,再次发生尿道狭窄3例,其余患者排尿通畅,最大尿流率从15．2～54．6（平均28．7）ml／s。结论：舌黏膜是一种修复前尿道狭窄较好的尿道替代物,双侧舌黏膜尿道成形能成功治疗长段、复杂性尿道狭窄。     

口腔黏膜尿道成形术治疗前尿道狭窄:单中心5年经验总结

目的探讨口腔黏膜尿道成形术治疗前尿道狭窄的有效性和安全性。方法 2011年6月至2016年6月利用口腔黏膜尿道成形术治疗105例前尿道狭窄,其中颊黏膜尿道成形25例、舌黏膜尿道成形80例。狭窄段长度为2.5~15cm,平均(7.31±3.42)cm。术前耻骨上膀胱造瘘85例;余20例术前最大尿流率2.2~10.2mL/s,平均(4.6±1.2)mL/s。结果术后随访6~59月,平均(38.6±10.4)月。术后患者排尿通畅98例(93.33%);尿动力学检查显示最大尿流率为16.2~37.4mL/s,平均(23.2±1.3)mL/s。7例(6.67%)出现尿道再狭窄,包含尿道外口狭窄2例、吻合口处状狭窄5例。尿道外口狭窄1例行尿道扩张后排尿通畅,1例行尿道外口成形。吻合口狭窄4例经历尿道扩张后排尿通畅,1例行颊黏膜尿道成形术后排尿通畅。所有患者均无感染,口腔黏膜移植物均存活,无尿道皮肤瘘发生。结论口腔黏膜可作为较理想的尿道替代物,适合多段或长段前尿道狭窄的修复治疗,颊黏膜和舌黏膜具有同等优势,而舌黏膜具有取材方便、材料充足等优点更适合于前尿道狭窄的治疗。     

颊黏膜尿道成形术治疗前尿道狭窄的临床分析

目的 探讨利用游离口腔颊黏膜尿道成形术治疗前尿道狭窄的疗效.方法 2011年6月至2012年12月采用颊黏膜腹侧扩大替代尿道成形术治疗25例前尿道狭窄,狭窄段长度为3.5～10 cm,平均5.74 cm.术前耻骨上膀胱造瘘16例,余9例术前最大尿流率2.4～7.6 mL/s,平均4.3 mL/s.结果 术后随访3～18个月,平均6.5个月.术后患者排尿通畅22例(88％),尿动力学检查显示最大尿流率为14～28mL/s,平均19.4 mL/s.3例(12％)吻合口处狭窄,经历尿道扩张后,排尿通畅.所有患者均无感染及尿道皮肤瘘发生,口腔颊黏膜移植物均成活.结论 口腔颊黏膜可作为较理想的尿道替代物,适合长段或多段狭窄的尿道修复.     

游离黏膜尿道成形治疗硬化性苔藓样病所致尿道狭窄的疗效观察

目的 提高对硬化性苔藓样病( lichen sclerosus,LS)导致尿道狭窄的认识,观察游离黏膜尿道成形治疗LS所致尿道狭窄的疗效. 方法 2007年1月-2010年12月收治LS所致前尿道狭窄患者36例,年龄27～75岁,平均41岁.尿道狭窄段长5.0 ～20.0 cm,平均11.5 cm.根据尿道狭窄段长短和严重程度选择不同的黏膜组织,其中行口腔内黏膜(舌、颊黏膜)尿道成形27例,结肠黏膜尿道成形8例,另1例老年患者行前尿道劈开.在行尿道重建术前对病变累及的阴茎头、尿道口、尿道行病理学检查. 结果 36例患者术后3周拔除导尿管,排尿通畅;活检结果提示上皮基底部特征性病变,过度角化,上皮层变薄,淋巴细胞浸润等.术后随访6 ～ 50个月,平均22个月.出现尿道外口狭窄3例(8.3％),其中口腔内黏膜尿道成形者2例,结肠黏膜重建尿道者1例,行尿道外口切开后排尿通畅.余患者术后排尿通畅,最大尿流率17.2～47.0 ml/s,平均23.4 ml/s. 结论 采用游离黏膜尿道成形治疗LS所致尿道狭窄疗效较好,但需密切随访,因病变迁延可致尿道再狭窄,尤其是尿道口再狭窄.     

游离黏膜组织重建尿道治疗复杂性尿道狭窄的临床研究

目的 探讨利用游离黏膜一期尿道成形治疗复杂性尿道狭窄或闭锁的疗效。方法 2000年8月至2004年7月采用2种游离黏膜一期尿道成形术治疗73例复杂性尿道狭窄。术前42例已行耻骨上膀胱造瘘，余31例最大尿流率1．2～6．5ml／s。用游离结肠黏膜(n=22)重建尿道长10～18cm，平均13cm；用口腔黏膜(n=51)重建尿道长3～11cm，平均5cm。术后随访分别行逆行尿道造影及尿流率，部分患者行尿道镜检查。结果随访2～48个月，平均19个月。术后排尿通畅67例(91．8％)。发生再次狭窄4例，其中结肠黏膜重建者1例，口腔黏膜重建者3例；排尿欠畅2例，定期行尿道扩张；尿道皮肤瘘2例；结肠腹壁瘘1例。1例结肠黏膜重建尿道者术后47个月移植物活检示结肠黏膜的组织形态学基本无变化。结论口腔与结肠黏膜均可作为较理想的尿道替代物，口腔黏膜较适合狭窄段不长的尿道修复，结肠黏膜较适合复杂性超长段尿道狭窄或缺损的治疗。     

阴囊纵隔皮瓣尿道成形术治疗长段前尿道狭窄

目的 总结阴囊纵隔皮瓣尿道成形术治疗长段前尿道狭窄的手术经验.方法 本组41例患者,年龄17～76岁,平均42.7岁,病程4～38个月,平均15个月.术前经逆行尿道造影、排泄性膀胱尿道造影均证实前尿道狭窄.狭窄段长度3cm～7cm,平均4.1 cm.术前27例尿流率测定均为低平曲线,最大尿流率3.5～6.9 ml/s,平均5.7 ml/s.运用阴囊纵隔皮瓣尿道成形术治疗长段前尿道狭窄.结果 41例患者随访12～36个月,平均23.1个月.术后排尿通畅39例,测定最大尿流率16～36ml/s,平均17.2 ml/s.出现并发症4例,其中尿道狭窄2例,尿道毛石形成2例,本组无尿瘘发生.结论 运用阴囊纵隔皮瓣尿道成形术治疗长段前尿道狭窄,手术成功率高,并发症少,是治疗长段前尿道狭窄的良好术式.     

舌黏膜补片治疗复杂性尿道狭窄的疗效观察

目的：探讨使用舌黏膜补片尿道成形治疗复杂性尿道狭窄的有效性。方法：2006年12月～2009年1月应用舌黏膜补片法治疗复杂性前尿道狭窄患者36例。结果：术后随访3～25个月，平均13．6个月。2例术后出现尿瘘，经再次手术修补后好转；另2例术后出现尿道狭窄，经尿道扩张后治愈。余者术后排尿通畅，平均最大尿流率达23．8ml／s。结论：舌黏膜具有取材方便、取材部位并发症少等优点，是一种治疗前尿道狭窄较好的替代物。     

结肠粘膜重建尿道治疗复杂性尿道狭窄的探讨

目的 探讨结肠粘膜替代尿道治疗复杂性较长段尿道狭窄或闭锁的可能性。方法 采用结肠粘膜重建尿道一期尿道成形术治疗6例复杂性较长段尿道狭窄，患者术前有平均3次不成功的尿道修复史，用结肠粘膜重建的尿道长10－15cm，平均12.7cm。术后随访时分别行逆行尿道造影，尿道镜和尿流率检查。结果 术后随访3－14个月，平均7.8个月。1例在术后3个月并发尿道外口狭窄性，经手术矫正后排尿通畅，术后1年随访时最大尿流率28.7ml/s。余5例术后排尿通畅，最大尿流率大于15ml/s。术后6个月4例经尿道镜检查，肉眼较难将尿道的结肠粘膜与正常的尿道粘膜相区别。结论 结肠粘膜重建尿道治疗较长段尿道狭窄或闭锁是一种可行而有效的方法，适合阴茎皮肤或膀胱粘膜利用有困难时的尿道重建。     

Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture

PURPOSE: We report the early outcome of dorsal full-thickness penile skin grafts in the repair of bulbar urethral stricture. MATERIALS AND METHODS: During 27 months 29 men with a mean age of 43 years (range 10 to 81) underwent dorsal onlay graft urethroplasty. Followup included retrograde urethrogram at 3 weeks, 3 months and 12 to 18 months, and thereafter when needed. Urinary flow was recorded as subjectively reported by the patients. RESULTS: The technique was used only for bulbar urethral strictures. A total of 23 patients (79%) had undergone previous direct vision urethrotomy and/or open surgery. Dorsal onlay graft urethroplasty was used alone in 12 patients (41%), and was performed with partial stricture excision and ventral strip anastomosis in 13 (45%). In another 4 patients (14%) the procedure was combined with an Orandi flap because the stricture extended significantly into the penile urethra. Penile skin grafts were used in 27 patients (93%), whereas buccal mucosa was harvested in 2. Mean graft length was 6 cm. (range 3 to 9), and width ranged between 1.5 and 3 cm. Outcome was favorable in 28 patients (97%) for a median followup of 19 months (range 10 to 37). One patient had symptomatic proximal stricture recurrence and 3 had radiographic evidence of caliber decrease of the repair but with no impact on urinary flow. CONCLUSIONS: Dorsal onlay graft urethroplasty is a versatile procedure which may be combined with stricture excision and ventral strip anastomosis or an Orandi flap. Conceptually the technique offers the advantages of spread fixation of the graft on a fixed well vascularized surface, which may improve graft neovascularization, reduce graft shrinkage and avoid sacculation. Although the early outcome is promising, dorsal onlay graft urethroplasty has yet to stand the test of time.     

Oral mucosal grafts urethroplasty for the treatment of long segmented anterior urethral strictures

Objective  To evaluate the efficacy and safety of using oral mucosal grafts for urethroplasty in the treatment of complex segmented urethral strictures. Methods  Between January 2002 and January 2008, 25 cases of long or multi-segmented urethral strictures (10–18 cm, mean 11.72) were treated using combined two oral mucosal graft urethroplasty. Of the 25 patients, combined double buccal mucosal graft (BMG) urethroplasty was performed in nine patients, double lingual mucosal graft (LMG) urethroplasty in seven patients and combined lingual and buccal mucosal graft urethroplasty in nine patients. Results  Follow-up was obtained for 6–72 months (mean 26.83) post-operatively. Urethrocutaneous fistulas developed in two patients. Urethral strictures developed in one patient undergoing BMG urethroplasty; the patient underwent five urethral dilations, after which he voided well with a urinary peak flow of 26.4 ml/s. Meatal stenosis developed in one patient undergoing LMG and a second operation was required, after which the patient voided well (urinary peak flow of 28.7 ml/s). The other patients voided well and urinary peak flow rates ranged from 16.8 to 49.2 ml/s (mean 28.65 ml/s). Conclusion  Combined two oral mucosal grafts substitution urethroplasty is an effective technique for the treatment of long, segmented urethral strictures.     

Multi-institutional experience with buccal mucosa onlay urethroplasty for bulbar urethral reconstruction

PURPOSE: Buccal mucosa has been advocated as an ideal graft material for urethral reconstruction. We report our multicenter experience with buccal mucosa ventral onlay urethroplasty for complex bulbar urethral reconstruction in adults. MATERIALS AND METHODS: A retrospective analysis of patients who had undergone buccal onlay urethroplasty at 4 military medical treatment facilities participating in the Uniformed Services Urology Research Group was performed. The database generated included demographic data, genitourinary history, preoperative symptoms (American Urological Association symptom score), preoperative urinary flow rate, stricture length and operative statistics. Postoperative followup data included symptom score, flow rate, retrograde urethrogram results, and complications. RESULTS: A total of 53 patients (average age 32 years, range 17 to 64) underwent buccal mucosa graft urethroplasty between January, 1996 and March, 1998 for refractory strictures. Sixteen patients had undergone an average of 2.2 prior endoscopic procedures (range 1 to 7). Average stricture length was 3.6 plus or minus standard deviation 1.8 cm. (range 2 to 7.5) as measured on preoperative retrograde urethrogram. Followup averaged 25 months (range 11 to 40 months). Average symptom scores decreased from 21.2 (range 14 to 33) preoperatively to 5.4 (range 3 to 8) postoperatively (p <0.001). Average peak urinary flow rates increased from 7.9 preoperatively to 30.1 ml. per second postoperatively (p <0.001). Postoperative retrograde urethrograms were available for 34 patients and were normal in 24. The overall complication rate was 5.4%. Three patients required endoscopic incisions. One patient has a recurrent narrowing and treatment is considered a failure. There were 4 sacculations (7.5%) and 6 narrowings, 3 of which required further treatment. Of the patients 50 required no additional procedures (94.3%). CONCLUSIONS: Buccal mucosa grafts used as a ventral onlay for bulbar urethral reconstruction yield reproducibly excellent results with minimal morbidity and low complication rates. Longer followup will be required to confirm the durability of our results.     

阴茎头硬化性苔藓样变及并发前尿道狭窄的临床分析

目的：提高对阴茎头硬化性苔藓样变（LS）及由此引起的前尿道狭窄的认识,并探讨合理的手术治疗方法。方法：15例LS并发前尿道狭窄的患者,年龄27～75岁,尿道狭窄段长4～16cm。采用舌黏膜尿道成形11例、结肠黏膜尿道成形2例;尿道外口切开及前尿道劈开术各1例。所有患者手术同时行LS病变组织病理学检查。结果：术后随访6～12个月（平均10．07个月）。1例游离结肠黏膜尿道成形患者术后2月发生尿道外口狭窄。行尿道外口切开后排尿道通畅;余者术后排尿通畅,Qmax：17．2～32ml／s（平均18．70ml／s）。结论：采用游离黏膜尿道成形治疗LS性尿道狭窄可取得较好效果,但需密切随访病变迁延致尿道再狭窄。     

结肠黏膜尿道成形治疗复杂性超长段尿道狭窄的长期疗效

目的 观察结肠黏膜尿道成形术治疗复杂性超长段尿道狭窄的长期效果和影响因素. 方法 2000年10月至2009年9月采用结肠黏膜尿道成形治疗复杂性超长段尿道狭窄46例.年龄17 ～70岁,平均39岁.尿道狭窄段长10.0～20.0 cm,平均15.2 cm.术前有平均2.7次不成功的尿道修复史.通过定期门诊或电话随访进行术后疗效评估,包括排尿情况和尿流率检查,部分患者行尿道造影和尿道镜检查等.以不需要任何处理包括尿道扩张,能正常排尿,尿流率在正常范围内者视为手术成功. 结果 结肠黏膜重建尿道的长度为11.0～21.0 cm,平均15.4 cm.1例失访,余45例随访20～120个月,平均62个月.发生与手术相关的并发症4例(8.9％),其中3例于术后3、8和24个月发生尿道外口狭窄,1例术后29个月发生结肠黏膜新尿道与尿道近端吻合口狭窄.另2例发生与结肠黏膜尿道成形术无关的尿道狭窄. 结论 结肠黏膜尿道成形术治疗复杂性超长段尿道狭窄术后长期效果理想;影响术后效果的因素是尿道口狭窄和吻合口狭窄.     

小肠黏膜下脱细胞基质修复前尿道狭窄的疗效分析

目的 探讨小肠黏膜下脱细胞基质(small intestinal submucosa,SIS)修复前尿道狭窄的可行性和有效性.方法 2009年6月至2010年8月采用4层SIS补片修复治疗尿道狭窄患者18例.患者年龄20～69岁,平均38岁;尿道狭窄段3.5～7.0 cm,平均4.6 cm;术前最大尿流率1.5～5.5 ml/s,平均3.8 ml/s.术中按需将SIS(长4.0～7.5 cm,宽 2.0 cm)植入尿道背侧缺损处,5-0可吸收线将SIS间断固定在阴茎海绵体上,SIS两侧与已剪开的狭窄段尿道作连续缝合,两端分别与尿道断端作间断吻合.结果 手术过程顺利,术后恢复好.随访6～18个月,平均10个月,患者未发生感染、排斥反应等并发症.17例排尿通畅,最大尿流率14.0～44.0 ml/s,平均25.4 ml/s.尿道造影显示尿道通畅;术后4、6周尿道镜检查示SIS移植物与周围组织分界清楚;术后14周尿道镜检查SIS已降解,修复段尿道与周围组织间限消失,黏膜光洁完整,管腔无明显狭窄;植入SIS部位活检显示黏膜表层为上皮细胞.1例尿道下裂术后患者术后5个月出现轻度尿道狭窄症状,行尿道扩张治疗.结论 利用SIS修复尿道狭窄具有创伤小、抗感染力强的特点,可作为组织工程尿道修复重建材料修复部分尿道狭窄患者.

Abstract：

Objective To investigate the feasibility of using small intestinal submucosa (SIS) graft for the repair of anterior urethral strictures. Methods From June 2009 to August 2010, 18 men (mean age, 38 yrs) with anterior urethral strictures underwent urethroplasty using a four-layer SIS as an onlay patch graft. SIS was used to augment the urethral caliber at the stricture site. The mean stricture length was 4.6 cm (range 3.5 to 7 cm). The pre-operative mean maximal flow rate was 3.8 ml/s (range 1.5 to 5.5 ml/s). The required SIS grafts (4 to 7.5 cm long and 2 cm wide) were positioned into the urethrotomy defect and were spread-fixed to the corpora cavernosa using 5-0 polyglactin interrupted sutures. Two apices of the graft were sutured to the proximal and distal apices of the urethrotomy with 5-0 polyglactin interrupted stitches. The margins of the opened urethra were sutured to the SIS patch with 5-0 polyglactin running sutures. Results The mean follow-up period was 10 mon. (range 6-18 mon.). No postoperative complication, such as infection or rejection related to the use of heterologous graft material was observed. Seventeen patients voided well postoperatively with the mean peak urine flow of 25.4 ml/s (14-44 ml/s). Cystoscopy revealed that at four weeks and six weeks, the SIS graft was well distinguishable from the normal surrounding tissue; and at 16 weeks, the urothelium was regenerated and the biomaterial was not distinguishable from the normal surrounding tissue. The squamosal epithelium was seen in the histological examination of the grafts. The remaining one patient with failed hypospadias developed a slight urethral narrowing at five months post-operatively and needed sound dilatations. Conclusions SIS matrix appears to be a safe and effective reconstructive material in selected urethral reconstructions.