Clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP

Q4 Medicine

中华泌尿外科杂志 Pub Date : 2019-12-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2019.12.008

Xiaofang Bi, Ping Qinrong, Wang Chunhui, Yang Yang, Libing Hu, Yiming Zhong, Jian Li, Ying Zheng

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The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken. \n \n \nResults \nThe operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml. The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative. 4 weeks after surgery, no signs of urethral stricture were observed in urethrography. And the maximum flow rate was >15 ml/s in 13 cases, while 3 cases was 10-15 ml/s. The mean maximum flow rate in postoperative was [(20.4±7.3) ml/s], which was significantly higher than that in preoperative (t=7.7602, P<0.05). B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume <30 ml. All patients had no serious complications such as urinary fistula, urethral diverticulum and extravasation of urine. After 1 year of follow-up, 1 patient was lost to follow up, and none of the remaining15 cases had urethral obstruction due to re-stricture. \n \n \nConclusion \nDorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP. \n \n \nKey words: \nUrethral stricture; Free flap; Dorsal mosaic; Transurethral resection of the prostate","PeriodicalId":10343,"journal":{"name":"中华泌尿外科杂志","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"中华泌尿外科杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.008","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Objective To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP. Methods We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan′an hospital affiliated to Kunming medical university retrospectively. The patients' age ranged from 58 to 75 years, with an average of 64.3 years. The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken. Results The operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml. The symptoms of dysuria were relieved in all patients after removal of the catheter at 3 weeks postoperative. 4 weeks after surgery, no signs of urethral stricture were observed in urethrography. And the maximum flow rate was >15 ml/s in 13 cases, while 3 cases was 10-15 ml/s. The mean maximum flow rate in postoperative was [(20.4±7.3) ml/s], which was significantly higher than that in preoperative (t=7.7602, P<0.05). B-ultrasound showed 13 cases without residual urine and 3 cases of residual urine volume <30 ml. All patients had no serious complications such as urinary fistula, urethral diverticulum and extravasation of urine. After 1 year of follow-up, 1 patient was lost to follow up, and none of the remaining15 cases had urethral obstruction due to re-stricture. Conclusion Dorsal mosaic surgery with penis free flap could be an effective method and had no obvious complications for the treatment of anterior urethral stricture after TURP. Key words: Urethral stricture; Free flap; Dorsal mosaic; Transurethral resection of the prostate

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阴茎游离皮瓣背侧马赛克手术治疗TURP术后前尿道狭窄的临床疗效

目的探讨阴茎游离皮瓣背侧马赛克手术治疗TURP术后前尿道狭窄的临床疗效。方法回顾性分析2010年1月至2017年12月昆明医科大学附属延安医院经尿道手术后前尿道狭窄患者的临床资料。患者年龄58 ~ 75岁，平均64.3岁。从TURP到诊断前尿道狭窄的时间为1-12个月，平均3.5个月。阴茎节段尿道狭窄5例，阴茎与阴囊交界处尿道狭窄11例，狭窄尿道长度为2 ~ 5 cm，平均3.4cm。术前平均最大尿流量为(5.3±2.7)ml/s。常规尿道扩张治疗11例，治疗持续时间均在6个月以上，经尿道切开联合尿道扩张治疗5例(1 ~ 2次)。16例经以上治疗无效，均行阴茎游离皮瓣背侧马赛克手术治疗。蛛网膜下腔联合硬膜外麻醉，患者取仰卧位。尿道扩张器确定尿道狭窄远端。从尿道腹侧切开。根据尿道血管造影显示的尿道狭窄长度，将切口长度延长0.5 cm。解剖尿道左右两侧狭窄，纵向切开尿道海绵体腹侧。切口长度延长0.5 cm至正常尿道粘膜。牵引线沿两侧牵拉尿道腹侧缘。将尿道背侧相应内侧线切入白膜，将尿道背侧边缘与白膜分离，在白膜上形成椭圆形区域。根据椭圆区大小取阴茎皮瓣全厚，皮瓣大小超出椭圆区边缘约0.3 cm。游离皮瓣在椭圆区(皮肤表面在尿道内侧)用6-0可吸收缝线覆盖，游离皮瓣边缘与尿道背侧边缘间歇缝合，多针间断缝合皮瓣表面于海绵体床上。使用硅胶导管作为新尿道的支架管，6-0可吸收缝线闭合切口尿道海绵的腹侧。缝合多层肉膜以防止尿漏，并逐层缝合筋膜与皮肤。取包皮后用5-0可吸收线缝合伤口。结果手术顺利完成。手术时间90 ~ 120 min，平均102.3 min。术中出血量10 ~ 30 ml。术后3周拔除导管后，所有患者排尿困难症状均得到缓解。术后4周，尿道造影未见尿道狭窄征象。13例最大流速为bb0 ~ 15ml /s, 3例为10 ~ 15ml /s。术后平均最大血流速率为[(20.4±7.3)ml/s]，显著高于术前(t=7.7602, P<0.05)。b超示无残尿13例，残尿量<30 ml 3例，均无尿瘘、尿道憩室、尿外渗等严重并发症。随访1年，1例患者失访，其余15例患者均未发生尿道再狭窄梗阻。结论阴茎游离皮瓣背侧马赛克手术是治疗TURP术后前尿道狭窄的有效方法，无明显并发症。关键词:尿道狭窄;自由皮瓣;背马赛克;经尿道前列腺切除术

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.