Use of bulbospongiosus muscle for repair of traumatic posterior urethral stenosis combined with urethrorectal fistulas

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2025-04-02 DOI:10.1111/bju.16709

Changhao Hou, Jianwen Huang, Weidong Zhu, Kaile Zhang, Nailong Cao, Tao Liang, Guoping Song, Jiong Zhang, Qiang Fu, Lujie Song

{"title":"Use of bulbospongiosus muscle for repair of traumatic posterior urethral stenosis combined with urethrorectal fistulas","authors":"Changhao Hou, Jianwen Huang, Weidong Zhu, Kaile Zhang, Nailong Cao, Tao Liang, Guoping Song, Jiong Zhang, Qiang Fu, Lujie Song","doi":"10.1111/bju.16709","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objective</h3>\n \n <p>To evaluate the efficacy and functional outcomes of bulbospongiosus muscle (BSM) flap interposition in the repair of urethral stenosis combined with urethrorectal fistula (USURF) or anterior rectal wall weakness (USRW).</p>\n </section>\n \n <section>\n \n <h3> Patients and Methods</h3>\n \n <p>Between January 2016 and December 2023, 36 patients underwent transperineal posterior urethroplasty with BSM flap interposition. 36 patients with traumatic posterior urethral stenosis who underwent perineal urethroplasty without interposition of the BSM as the control group, matched by propensity score analysis during the same period. Pre- and intra-operative clinical data were collected. Functional outcomes, including voiding, erectile, and ejaculatory function, were compared between the two groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 36 males were included, of whom 19 (52.8%) had USURF and 17 (47.2%) had USRW. The mean follow-up time was 31.3 ± 17.7 months. The overall success rate was 94.4%. The median operating time was 3.0 (2.0, 3.0) h. The mean stricture length was 4.2 ± 1.2 cm. The mean postoperative maximum urinary flow rate was 24.2 ± 12.9 mL/s. Postoperative functional outcomes did not significantly differ between BSM interposition and BSM non-interposition group as assessed by Incontinence Questionnaire Male Lower Urinary Tract Symptoms (5.0 vs 3.0; <i>P</i> = 0.399), the International Index of Erectile Function 5 (3.0 vs 6.5; <i>P</i> = 0.183), Erection Hardness Score (<i>P</i> = 0.801), the Male Sexual Health Questionnaire 4 (1.0 vs 1.0; <i>P</i> = 1.00), European Quality of Life-5 Dimensions (0.9 ± 0.1 vs 0.9 ± 0.1; <i>P</i> = 0.139), EQ-VAS scores (75.9 ± 20.0 vs 79.9 ± 18.7; <i>P</i> = 0.428), urine dribbling (2.0 vs 1.5, <i>P</i> = 0.727), ejaculation volume (2.0 vs 2.0, <i>P</i> = 0.631) and ejaculation intensity (3.0 vs 4.0, <i>P</i> = 0.645).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Transperineal BSM flap interposition combined with anastomosis urethroplasty and urethrorectal fistula repair is a safe and effective treatment. BSM can strengthen the anterior rectal wall and separate the urethral anastomosis from the repaired rectal fistula, which should improve the success rate of fistula repair.</p>\n </section>\n </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"135 6","pages":"1049-1057"},"PeriodicalIF":3.7000,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BJU International","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/bju.16709","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To evaluate the efficacy and functional outcomes of bulbospongiosus muscle (BSM) flap interposition in the repair of urethral stenosis combined with urethrorectal fistula (USURF) or anterior rectal wall weakness (USRW).

Patients and Methods

Between January 2016 and December 2023, 36 patients underwent transperineal posterior urethroplasty with BSM flap interposition. 36 patients with traumatic posterior urethral stenosis who underwent perineal urethroplasty without interposition of the BSM as the control group, matched by propensity score analysis during the same period. Pre- and intra-operative clinical data were collected. Functional outcomes, including voiding, erectile, and ejaculatory function, were compared between the two groups.

Results

A total of 36 males were included, of whom 19 (52.8%) had USURF and 17 (47.2%) had USRW. The mean follow-up time was 31.3 ± 17.7 months. The overall success rate was 94.4%. The median operating time was 3.0 (2.0, 3.0) h. The mean stricture length was 4.2 ± 1.2 cm. The mean postoperative maximum urinary flow rate was 24.2 ± 12.9 mL/s. Postoperative functional outcomes did not significantly differ between BSM interposition and BSM non-interposition group as assessed by Incontinence Questionnaire Male Lower Urinary Tract Symptoms (5.0 vs 3.0; P = 0.399), the International Index of Erectile Function 5 (3.0 vs 6.5; P = 0.183), Erection Hardness Score (P = 0.801), the Male Sexual Health Questionnaire 4 (1.0 vs 1.0; P = 1.00), European Quality of Life-5 Dimensions (0.9 ± 0.1 vs 0.9 ± 0.1; P = 0.139), EQ-VAS scores (75.9 ± 20.0 vs 79.9 ± 18.7; P = 0.428), urine dribbling (2.0 vs 1.5, P = 0.727), ejaculation volume (2.0 vs 2.0, P = 0.631) and ejaculation intensity (3.0 vs 4.0, P = 0.645).

Conclusions

Transperineal BSM flap interposition combined with anastomosis urethroplasty and urethrorectal fistula repair is a safe and effective treatment. BSM can strengthen the anterior rectal wall and separate the urethral anastomosis from the repaired rectal fistula, which should improve the success rate of fistula repair.

查看原文本刊更多论文

球海绵肌修复外伤性后尿道狭窄合并尿道直肠瘘。

目的：评价球海绵肌（BSM）瓣介入修复尿道狭窄合并尿道直肠瘘（篡位）或直肠前壁无力（USRW）的疗效和功能结局。患者和方法：2016年1月至2023年12月，36例患者行BSM瓣介入经会阴后尿道成形术。36例外伤性后尿道狭窄患者行会阴尿道成形术，无BSM介入，作为对照组，同期进行倾向评分分析。收集术前和术中临床资料。功能结果，包括排尿、勃起和射精功能，在两组之间进行比较。结果：共纳入36例男性患者，其中19例（52.8%）存在篡位f， 17例（47.2%）存在USRW。平均随访31.3±17.7个月。总成功率为94.4%。中位手术时间3.0 (2.0,3.0)h，平均狭窄长度4.2±1.2 cm。术后平均最大尿流率为24.2±12.9 mL/s。失禁问卷男性下尿路症状评估显示，BSM介入组和BSM非介入组术后功能结果无显著差异(5.0 vs 3.0；P = 0.399)，国际勃起功能指数5 (3.0 vs 6.5；P = 0.183)、勃起硬度评分（P = 0.801）、男性性健康问卷4 (1.0 vs 1.0；P = 1.00)，欧洲生活质量5维度(0.9±0.1 vs 0.9±0.1；P = 0.139), EQ-VAS得分(75.9±20.0 vs 79.9±18.7;P = 0.428)，尿滴（2.0 vs 1.5, P = 0.727），射精量（2.0 vs 2.0, P = 0.631）和射精强度（3.0 vs 4.0, P = 0.645）。结论：经会阴BSM瓣间置联合吻合口尿道成形术和尿道直肠瘘修补术是一种安全有效的治疗方法。BSM可以加强直肠前壁，使尿道吻合口与修复的直肠瘘分离，应能提高瘘口修复的成功率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.