尿道转位阴茎海绵体脚下吻合性尿道成形术治疗复杂性后尿道狭窄的疗效分析

Urethra rerouted under corpora cavernosus anastomotic urethroplasty for treatment of complex posterior urethral strictures

目的探讨尿道转位阴茎海绵体脚下吻合性尿道成形术治疗复杂性后尿道狭窄的疗效。方法回顾性分析2008年6月至2020年6月采用切除狭窄段尿道行尿道转位一侧阴茎海绵体脚下吻合性尿道成形术治疗35例复杂性后尿道狭窄患者的临床资料。患者年龄3~54岁,平均25.2岁;尿道狭窄段长度4~7 cm,平均5.2 cm;其中6例尿道狭窄合并尿道直肠瘘。手术步骤包括:①游离前尿道长度>5 cm,分开阴茎海绵体中隔,切除耻骨下缘,分离出后尿道远端开口;②在左侧阴茎海绵体下方分离出一条通道到耻骨下缘,前尿道转位绕到阴茎海绵体下缘与后尿道进行无张力吻合。结果术后2例失访,余33例随访3~144个月,平均37个月。32例(97%)排尿通畅,21例行尿流率检查,其中7例儿童患者最大尿流率为13.6~35.5 ml/s,平均17.5 ml/s;14例成人患者最大尿流率为16.3~77.6 ml/s,平均27.9 ml/s。6例合并尿道直肠瘘患者均成功修复,其中1例于术后第6年死于脑干出血。29例控尿良好,3例有不同程度的尿失禁。1例术后尿道狭窄复发,再次行该术式尿道成形术修复成功。结论尿道转位阴茎海绵体脚下吻合性尿道成形术治疗复杂性长段后尿道狭窄不仅效率高、复发率低,而且不会引起阴茎海绵体弯曲和影响阴茎海绵体发育。

Objective To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods Between June 2008 and June 2020,35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty.The patients’age was 3-54 years(mean 23.2 years),the urethral stricture or loss length was 4-7 cm(mean 5.2 cm),and 6 patients associated with urethrorectal fistula.The technique involved:①The anterior urethra is dissected long more than 5 cm,separation of the proximal corporeal bodies,inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results Two patients lost follow-up;the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months).Thirty-two patients could void normally(97%),The examination of maximal urinary flow rates(Qmax)were taken in 21 patients,of whom Qmax was 13.6-35.5 ml/s(mean 17.5 ml/s)in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s)in 14 adult patients.All 6 patients associated with urethrorectal fistula successful repaired,of these patients 1 had died of hemorrhage of brain 6 years postop.One patient developed urethral stenosis postoperatively.Continence was achieved in 29 patients,the remaining 3 patients had incontinence from mild to moderate.Conclusions Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option,with low recurrent rate for patients with complex posterior urethral strictures,but also do not cause curve and affect growth of corpora cavernosus.