摘要 The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
Abstract: The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury.Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty.There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee.More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique.Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results.It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
Christopher J. Hillary, Nadir I. Osman, Christopher R. Chapple. Current trends in urethral stricture management[J]. Asian Journal of Urology, 2014, 1(1): 44-51.
Christopher J. Hillary, Nadir I. Osman, Christopher R. Chapple. Current trends in urethral stricture management. Asian Journal of Urology, 2014, 1(1): 44-51.
Liu JS, Walker K, Stein D, Prabhu S, Hofer MD, Han J, et al. Lichensclerosus and isolated bulbar urethral stricture disease. J Urol 2014;192: 775-9.
[7]
Chapple C, Barbagli G, Jordan G, Mundy AR, Rodrigues-Netto N,Pansadoro V, et al. Consensus statement on urethral trauma. BJU Int2004; 93: 1195-202.
[8]
Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R,Oosterlinck W. Etiology of urethral stricture disease in the 21stcentury. J Urol 2009; 182: 983-7.
[9]
Morey AF, McAninch JW, Duckett CP, Rogers RS. AmericanUrological Association symptom index in the assessment ofurethroplasty outcomes. J Urol 1998; 159: 1192-4.
[10]
Heyns CF, Marais DC. Prospective evaluation of the AmericanUrological Association symptom index and peak urinary flow ratefor the follow-up of men with known urethral stricture disease. JUrol 2002; 168: 2051-4.
[11]
Jackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, ChappleCR, et al. A prospective patient-centred evaluation of urethroplastyfor anterior urethral stricture using a validated patient-reportedoutcome measure. Eur Urol 2013; 64: 777-82.
[12]
Smith JC. Urethral resistance to micturition. Br J Urol 1968; 40:125-56.
[13]
Jordan GH, Eltahawy EA, Virasoro R. The technique of vesselsparing excision and primary anastomosis for proximal bulbousurethral reconstruction. J Urol 2007; 177: 1799-802.
[14]
Hadjizacharia P, Inaba K, Teixeira PG, Kokorowski P, DemetriadesD, Best C. Evaluation of immediate endoscopic realignment as atreatment modality for traumatic urethral injuries. J Trauma 2008;64: 1443-50.
[15]
McAninch JW, Laing FC, Jeffrey RB Jr. Sonourethrography in theevaluation of urethral strictures: a preliminary report. J Urol 1988;139: 294-7.
[16]
Koraitim MM, Reda IS. Role of magnetic resonance imaging inassessment of posterior urethral distraction defects. Urology 2007;70: 403-6.
[17]
Webster GD, Ramon J. Repair of pelvic fracture posterior urethraldefects using an elaborated perineal approach: experience with 74cases. J Urol 1991; 145: 744-8.
[18]
Morey AF, McAninch JW. Reconstruction of posterior urethraldisruption injuries: outcome analysis in 82 patients. J Urol 1997;157: 506-10.
Singh BP, Andankar MG, Swain SK, Das K, Dassi V, Kaswan HK, etal. Impact of prior urethral manipulation on outcome of anastomoticurethroplasty for post-traumatic urethral stricture. Urology 2010; 75:179-82.
[21]
Borboroglu PG, Sands JP, Roberts JL, Amling CL. Risk factors forvesicourethral anastomotic stricture after radical prostatectomy.Urology 2000; 56: 96-100.
[22]
Park R, Martin S, Goldberg JD, Lepor H. Anastomotic stricturesfollowing radical prostatectomy: insights into incidence,effectiveness of intervention, effect on continence, and factorspredisposing to occurrence. Urology 2001; 57: 742-6.
[23]
Wessells H, Morey AF, McAninch JW. Obliterative vesicourethralstrictures following radical prostatectomy for prostate cancer:reconstructive armamentarium. J Urol 1998; 160: 1373-5.
[24]
Sikafi Z, Butler MR, Lane V, O'Flynn JD, Fitzpatrick JM. Bladderneck contracture following prostatectomy. Br J Urol 1985; 57:308-10.
[25]
Lawton CA, Bae K, Pilepich M, Hanks G, Shipley W. Long-termtreatment sequelae after external beam irradiation with or withouthormonal manipulation for adenocarcinoma of the prostate: analysisof radiation therapy oncology group studies 85-31, 86-10, and 92-02.Int J Radiat Oncol Biol Phys 2008; 70: 437-41.
[26]
Grills IS, Martinez AA, Hollander M, Huang R, Goldman K,Chen PY, et al. High dose rate brachytherapy as prostate cancermonotherapy reduces toxicity compared to low dose rate palladiumseeds. J Urol 2004; 171: 1098-104.
[27]
Sullivan L, Williams SG, Tai KH, Foroudi F, Cleeve L, DuchesneGM. Urethral stricture following high dose rate brachytherapy forprostate cancer. Radiother Oncol 2009; 91: 232-6.
[28]
Elliott SP, McAninch JW, Chi T, Doyle SM, Master VA.Management of severe urethral complications of prostate cancertherapy. J Urol 2006; 176(6 Pt 1): 2508-13.
[29]
Sachse H. [Cystoscopic transurethral incision of urethral stricturewith a sharp instrument (author's transl)]. MMW Munch MedWochenschr 1974; 116: 2147-50.
[30]
Santucci R, Eisenberg L. Urethrotomy has a much lower success ratethan previously reported. J Urol 2010; 183: 1859-62.
[31]
Steenkamp JW, Heyns CF, de Kock ML. Internal urethrotomy versusdilation as treatment for male urethral strictures: a prospective,randomized comparison. J Urol 1997; 157: 98-101.
[32]
Wright JL, Wessells H, Nathens AB, Hollingworth W. What is themost cost-effective treatment for 1 to 2-cm bulbar urethral strictures:societal approach using decision analysis. Urology 2006; 67: 889-93.
[33]
Naudé AM, Heyns CF. What is the place of internal urethrotomy inthe treatment of urethral stricture disease? Nat Clin Pract Urol 2005;2: 538-45.
[34]
Heyns CF, Steenkamp JW, De Kock ML, Whitaker P. Treatment ofmale urethral strictures: is repeated dilation or internal urethrotomyuseful? J Urol 1998; 160: 356-8.
[35]
Morgia G, Saita A, Morana F, Macaluso CP, Serretta V, Lanza P, etal. Endoprosthesis implantation in the treatment of recurrent urethralstricture: a multicenter study. Sicilian-Calabrian Urology Society. JEndourol 1999; 13: 587-90.
[36]
Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, JordanGH. Long-term follow-up for excision and primary anastomosis foranterior urethral strictures. J Urol 2007; 177: 1803-6.
[37]
Barbagli G, De Angelis M, Romano G, Lazzeri M. Long-termfollow-up of bulbar end-to-end anastomosis: a retrospective analysisof 153 patients in a single center experience. J Urol 2007; 178:2470-3.
[38]
Guralnick ML, Webster GD. The augmented anastomoticurethroplasty: indications and outcome in 29 patients. J Urol 2001;165: 1496-501.
[39]
Morey AF, Kizer WS. Proximal bulbar urethroplasty via extendedanastomotic approach—what are the limits? J Urol 2006; 175:2145-9.
[40]
Andrich DE, Mundy AR. Non-transecting anastomotic bulbarurethroplasty: a preliminary report. BJU Int 2012; 109: 1090-4.
[41]
Lumen N, Hoebeke P, Oosterlinck W. Ventral longitudinalstricturotomy and transversal closure: the Heineke-Mikuliczprinciple in urethroplasty. Urology 2010; 76: 1478-82.
[42]
Greenwell TJ, Venn SN, Mundy AR. Changing practice in anteriorurethroplasty. BJU Int 1999; 83: 631-5.
[43]
Welk BK, Kodama RT. The augmented nontransected anastomoticurethroplasty for the treatment of bulbar urethral strictures. Urology2012; 79: 917-21.
[44]
Barbagli G, Selli C, di Cello V, Mottola A. A one-stage dorsal freegrafturethroplasty for bulbar urethral strictures. Br J Urol 1996; 78:929-32.
[45]
Andrich DE, Leach CJ, Mundy AR. The Barbagli procedure givesthe best results for patch urethroplasty of the bulbar urethra. BJU Int2001; 88: 385-9.
[46]
Bhargava S, Chapple CR. Buccal mucosal urethroplasty: is it thenew gold standard? BJU Int 2004; 93: 1191-3.
[47]
Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, LazzeriM. Bulbar urethroplasty using buccal mucosa grafts placed on theventral, dorsal or lateral surface of the urethra: are results affected bythe surgical technique? J Urol 2005; 174: 955-8.
[48]
Barbagli G, Sansalone S, Romano G, Lazzeri M. Ventral onlay oralmucosal graft bulbar urethroplasty. BJU Int 2011; 108: 1218-31.
[49]
Kulkarni S, Barbagli G, Sansalone S, Lazzeri M. One-sided anteriorurethroplasty: a new dorsal onlay graft technique. BJU Int 2009;104: 1150-5.
[50]
Palminteri E, Manzoni G, Berdondini E, Di Fiore F, Testa G, PoluzziM, et al. Combined dorsal plus ventral double buccal mucosa graftin bulbar urethral reconstruction. Eur Urol 2008; 53: 81-9.
[51]
Mangera A, Patterson JM, Chapple CR. A systematic review of graftaugmentation urethroplasty techniques for the treatment of anteriorurethral strictures. Eur Urol 2011; 59: 797-814.
[52]
El-Kassaby AW, El-Zayat TM, Azazy S, Osman T. One-stage repairof long bulbar urethral strictures using augmented Russell dorsalstrip anastomosis: outcome of 234 cases. Eur Urol 2008; 53: 420-4.
[53]
Granieri MA, Webster GD, Peterson AC. The evolution ofurethroplasty for bulbar urethral stricture disease: lessons learnedfrom a single center experience. J Urol 2014; doi: 10.1016/j.juro.2014.05.085. [Epub ahead of print]
[54]
Orandi A. One-stage urethroplasty. Br J Urol 1968; 40: 717-9.
Whitson JM, McAninch JW, Elliott SP, Alsikafi NF. Long-termefficacy of distal penile circular fasciocutaneous flaps for singlestage reconstruction of complex anterior urethral stricture disease. JUrol 2008; 179: 2259-64.
[57]
Snodgrass W. Tubularized, incised plate urethroplasty for distalhypospadias. J Urol 1994; 151: 464-5.
[58]
Hayes MC, Malone PS. The use of a dorsal buccal mucosal graftwith urethral plate incision (Snodgrass) for hypospadias salvage.BJU Int 1999; 83: 508-9.
[59]
Asopa HS, Garg M, Singhal GG, Singh L, Asopa J, Nischal A.Dorsal free graft urethroplasty for urethral stricture by ventralsagittal urethrotomy approach. Urology 2001; 58: 657-9.
[60]
Barbagli G, Morgia G, Lazzeri M. Retrospective outcome analysis ofone-stage penile urethroplasty using a flap or graft in a homogeneousseries of patients. BJU Int 2008; 102: 853-60.
[61]
Kulkarni S, Barbagli G, Kirpekar D, Mirri F, Lazzeri M. Lichensclerosus of the male genitalia and urethra: surgical options andresults in a multicenter international experience with 215 patients.Eur Urol 2009; 55: 945-54.
[62]
Andrich DE, Greenwell TJ, Mundy AR. The problems of penileurethroplasty with particular reference to 2-stage reconstructions. JUrol 2003; 170: 87-9.
[63]
Barbagli G, Vallasciani S, Romano G, Fabbri F, Guazzoni G, LazzeriM. Morbidity of oral mucosa graft harvesting from a single cheek.Eur Urol 2010; 58: 33-41.
[64]
Xu YM, Sa YL, Fu Q, Zhang J, Si JM, Liu ZS. Oral mucosal graftsurethroplasty for the treatment of long segmented anterior urethralstrictures. World J Urol 2009; 27: 565-71.
[65]
Fiala R, Vidlar A, Vrtal R, Belej K, Student V. Porcine smallintestinal submucosa graft for repair of anterior urethral strictures.Eur Urol 2007; 51: 1702-8.
[66]
Palminteri E, Berdondini E, Fusco F, De Nunzio C, Salonia A. Longtermresults of small intestinal submucosa graft in bulbar urethralreconstruction. Urology 2012; 79: 695-701.
Christopher Hartman, Nikhil Gupta, David Leavitt, David Hoenig, Zeph Okeke, Arthur Smith. Advances in percutaneous stone surgery[J]. Asian Journal of Urology, 2015, 2(1): 26
-32
.
