Application of preputial circular pedicle flap in complex long segment urethral stricture
10.3760/cma.j.cn112330-20240301-00104
- VernacularTitle:包皮环形带蒂皮瓣在复杂性长段尿道狭窄中的应用
- Author:
Liujian DUAN
1
;
Yan XU
1
;
Jianwei CAO
1
;
Lin ZHANG
1
;
Xingang CUI
1
;
Chao LI
1
Author Information
1. 上海交通大学医学院附属新华医院泌尿外科，上海 200092
- Publication Type:Journal Article
- Keywords:
Urethral stricture;
Necrotizing fasciitis;
Urethral damage;
Urethral reconstruction
- From:
Chinese Journal of Urology
2024;45(11):848-851
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the application selection of preputial circular flap pedicle in the treatment of complex long segment urethral stricture.Methods:The data of 11 patients who underwent surgical reconstruction of the urethra for complex long segment urethral stricture between October 2019 and November 2022 in Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine were retrospectively analyzed. The patients’ average age was 46(range 40-66) years old, with average urethral stricture length of 7 (range 6-13) cm and average maximum preoperative urinary flow rate of 5 (range 3-7) ml/s. They had a history of recurrent urinary tract infections and endoscopic treatment for urinary tract stones. Among the 11 cases, one patient had necrotizing fasciitis of the scrotum with complete destruction and loss of the scrotal urethra. This patient received acute bladder diversion, surgical debridement, vacuum sealing drainage, and negative pressure suction during the acute phase. And six months later, a circular preputial pedicle flap was used to reconstruct a 12 cm urethral defect in the scrotal region. The remaining 10 patients underwent preputial circular flap pedicle onlay urethral reconstruction. The changes in the patient's maximum urinary flow rate, and the signs of restenosis, urinary fistula, or urethral diverticulum were analyzed.Results:All 11 patients who underwent preputial circular flap pedicle urethral reconstruction had unobstructed urination after surgery. Surgical time ranged from 96 to 246 min, with an average of 121 min. The intraoperative blood loss ranged from 10 to 200 ml, with an average of 46 ml. The hospital stay ranged from 6 to 13 d, with an average of 9 d. The indwelling catheterisation time ranged from 18 to 28 d, with an average of 20 d. The patients were followed-up for 9 to 32 months, with an average of 24 months. All 11 cases had smooth urinary flow after surgery, and the maximum urinary flow rate ranged from 16.1 to 24.2 ml/s, with an average of 17.6 ml/s, which was significantly higher than that before surgery. Two patients had post-void dribbling after four weeks, and imaging showed the formation of a diverticulum in the reconstructed segment of the urethra.Conclusions:Urethral reconstruction with preputial circular flap pedicle is a viable treatment option for complex long segment urethral stricture. The surgical outcomes are satisfactory, and the choice of treatment should be based on the patient's own conditions and the surgeon's technical expertise.
