Urethral stricture Yemen experience
Tóm tắt
In order to evaluate the etiology of urethral stricture in our society and outcome of different types of surgical reconstruction used to treat them. This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana’a, Yemen from July 2003 to July 2007 and included 62 male patients with complete urethral stricture whom underwent Urethral reconstructive surgery. The patients were evaluated by history, local and systemic physical examination, and radiological assessment according to each case. Patient’s age ranged between 3 and 70 years (mean 25.31). Of 55 patients presented to the GER, 31 patients had car accident, 14 patients had gun shot injury, 9 patients fell from high, and one patient had bomb explosion. Five patients had history of traumatized catheterization and urethrocystoscopy, while two patients had history of urethritis. The site of the stricture was at the bulbomembranous area in 43 patients, in the penile urethra in 14 patients, and in bulbous urethra in 5 patients. The length of the urethral stricture was 10–30 mm in 39 patients (63%), <10 mm in 13 patients (21%) and of 30–70 mm in 10 patients (16%). A total of 15 patients (24%) with posterior urethral stricture of 10 mm or less (+2 patients with 1.2 and 1.5 cm), subjected to endoscopic treatment, 37 patients (60%) with stricture >10–30 mm, were underwent anastomotic urethral reconstruction and 10 patients (15%) with stricture >30 mm, were repaired utilizing tissue transfer technique. Follow-up period ranged from 3 months to 2 years (median 15 months), in which recurrent stricture was found in 11 patients (18%), wound dehiscence in 4 patients (6%) and fistula formation in 1 patient (1.5%), while no patient came with erectile dysfunction. Trauma is the commonest cause of urethral stricture in our country, therefore the control of it will decrease extremely the urethral stricture disease. No one technique is suitable for all types of the stricture, and the surgeon should be familiar with the different techniques and choose the most suitable one according to the case he deals with.
Tài liệu tham khảo
McAninch JW (1996) Fasciocutaneous penile flap reconstruction of complex anterior urethral strictures. In: McAninch JW (ed) Traumatic and reconstructive urology. W.B. Saunders, Philadelphia, pp 609–613
Orandi A (1972) One stage urethroplasty: 4 years follow up. J Urol 107:977–979
Quartey JKM (1985) One stage penile preputial island flap urethroplasty for urethral stricture. J Urol 134:474–479
Akporiaye LE, Schlossberg SM, Jordan GH (1995) Hairless scrotal island flap urethroplasty. J Urol 153:372A
Carney JW, McAninch JW (2002) Penile circular fasciocutaneous flaps to reconstruct complex anterior urethral strictures. Urol Clin North Am 29:397–409. doi:10.1016/S0094-0143(02)00046-0
Morey AF, McAninch JW (1998) Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol 159:1209–1213. doi:10.1016/S0022-5347(01)63552-3
EL-Kassaby AW, Allah MF, Noweir A et al (1996) One stage anterior urethroplasty. J Urol 156:975–978. doi:10.1016/S0022-5347(01)65676-3
Wessels H, McAninch JW (1998) Current controversies in anterior urethral stricture repair: free graft versus pedicled skin flap reconstruction. World J Urol 16:175–180. doi:10.1007/s003450050048
Zinman L (1992) Muscular myocutaneous and fasciocutaneous flaps in complex urethral reconstruction. Urol Clin North Am 29:443–466
Barbagli G, Palmenteri E, Lazzeri M, Guazzoni G (2003) One stage circumferential buccal mucosa graft urethroplasty for bulbous stricture repair. Urology 169:1754–1757. doi:10.1097/01.ju.0000057800.61876.9b
Bhargava S, Chapple CR (2004) Buccal mucosal urethroplasty: is it the new gold standard? BJU Int 93:1991–1993
El-Kassaby AW, Fath Alla M, Noweir AM, Al-Halaby MR, Zakaria W, Elbialy MH (1993) The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol 149:276
Robert CF, Adriano AC, Raimundo JA, Antonio MJ, Vuldemar O (2007) The vaginalis dorsal graft urethroplasty: initial experience. Int Braz J Urol 33(4):523–531
Keating MA, Carlwright PC, Duckett JW (1990) Bladder mucosa for urethral reconstruction. J Urol 144:827–834
Koraitim MM (2005) ON the art of anastomotic posterior urethroplasty: a 27 year experience. J Urol 173(1):135–139
Santucci RA, McAninch JW (2001) Actuarial success rates of open urethral repair in 369 patients. J Urol 165(Suppl):13 (Abstract 54)
Pansadoro V, Emiliozzi P (1996) Internal urethrotomy in management of anterior urethral strictures: long-term follow up. J Urol 156:73–75. doi:10.1016/S0022-5347(01)65942-1
McAninch JW (1999) Traumatic and reconstructive urology. WB Saunders, Philadelphia, p 442
Koraitim MM (1995) The lessons of 145 post traumatic posterior urethral strictures treated in 17 years. J Urol 153:63. doi:10.1097/00005392-199501000-00024
Marey AF, McAninch JW (1997) Reconstructive of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol 157:506. doi:10.1016/S0022-5347(01)65188-7
Turner-warwick R (1989) Precaution of complications resulting from pelvic fracture urethral injuries and from their surgical management. Urol Clin North Am 16:335
Webster G, Pamon J (1991) Repair of Pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases. J Urol 154:744
Roehrborn CG, McConnell JD (1994) Analysis of factors contributing to success of failure of 1 stage urethroplasty for urethral stricture disease. J Urol 151:869–874
Hynes CF, Steenkamp JW, Dekock ML, Whitaker P (1998) Treatment of male urethral strictures: is repeated dilatation or internal urethrotomy useful? J Urol 160:356–358. doi:10.1016/S0022-5347(01)62894-5
Albers P, Fichtaer J, Bruhl P, Muller SC (1996) Long-term results of internal urethrotomy. J Urol 156:1611–1614. doi:10.1016/S0022-5347(01)65461-2
Sautucci RA, Mario LA, McAninch JW (2002) Anastomotic urethroplasty for balloon urethral stricture: analysis of 168 patients. J Urol 167:1715–1719. doi:10.1016/S0022-5347(05)65184-1
Zinman LM (2000) Q-flap reconstruction of pan urethral strictures. BJU Int 86:1039–1042. doi:10.1046/j.1464-410x.2000.00974.x