Одноэтапная уретропластика при протяженных стриктурах передней уретры: лоскут или графт?

Abstract

Introduction. Penile skin flap and oral mucosal graft are most often used for augmentation urethroplasty for extended anterior urethral strictures. It seems relevant to conduct a study comparing augmentation urethroplasty techniques using these donor materials. Materials and methods. The review is based on articles published throughout history in scientific peer-reviewed journals included in the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Embase (https://www.embase.com/landing), Cochrane Library (https://www.cochranelibrary.com/), Scientific Electronic Library eLibrary.ru (https://elibrary.ru/). The search was performed on the following keywords: «urethral stricture», «anterior urethra», «penile urethra», «bulbous urethra», «urethroplasty», «augmentation urethroplasty», «penile skin flap», «oral mucosa graft». At the first stage, 445 sources were found, of which 17 articles were included in the review. Results. A total of 17 original studies were identified with a comparative analysis between one-stage augmentation urethroplasty techniques using a penile skin flap and an oral mucosal graft for penile and/or bulbous urethral strictures. 7 (41,2%) studies were a randomized controlled trial, 10 (58,8%) studies were a retrospective cohort study. The total number of patients in whom a flap or graft was used across all studies was 1426. A penile skin flap was used in 638 (44,7%) patients, and an oral mucosal graft was used in 788 (55,3%) patients. The success of treatment using a penile skin flap averaged 77,8%, and an oral mucosal graft averaged 83,7%. Conclusions. Penile skin flap and oral mucosal graft, when used for augmentation urethroplasty, can achieve a similar treatment success rate. When assessing the outcome of urethroplasty in cohorts of patients with long-term postoperative follow-up and a relatively large sample size, the best results were characteristic of oral mucosal grafts.