Abstract
The paper presents the technique of the reconstruction of the bulbar and membranous urethra in the occurrence of strictures and sphincter-stenosis. The method uses an autologous graft and has potential advantages over the bulboprostatic anastomosis. Objective. To develop a method of helping patients with existing urethral anastomoses, with a damaged neck of the bladder and a risk of subsequent incontinence, wishing to maintain the erectile function. Materials and methods. 35 patients underwent 36 reconstructions of the urethra from August 2013 to July 2017, 11 - after previous urethral plastics, 14 - after prostate surgery (4 - after radical prostatectomy), 7 - suffered from a urethral distraction defect. The age of the patients was 58.17 ± 12.2 years. The median follow-up period was 525 (341; 813) days. The average length of urethral strictures was 15 (10; 15) mm. The average diameter of the urethra in the stricture zone was 1.4 ± 0.56 mm. Reconstruction with the use of a buccal mucosa graft is performed intraurethrally through corpus spongiosum using magnifying optics. Results. The overall efficacy of the primary reconstruction in 35 patients was 94.2 %; the repeated reconstruction in two patients was successful. All patients underwent the comprehensive monitoring of the results, the average follow-up period was 654 days, the average relapse-free period was 447 days. All patients preserved continence and erectile function Conclusion. The proposed technique showed a high efficiency in reconstruction of the bulbar and membranous urethra.
Highlights
Представлен способ реконструкции бульбо-мембранозного отдела уретры при стриктурах и сфинктерстенозах
The paper presents the technique of the reconstruction of the bulbar and membranous urethra in the occurrence of strictures and sphincter-stenosis
The proposed technique showed a high efficiency in reconstruction of the bulbar and membranous urethra
Summary
Представлен способ реконструкции бульбо-мембранозного отдела уретры при стриктурах и сфинктерстенозах. Общая эффективность при первичном выполнении у 35 пациентов – 91,4 %; повторная реконструкция, проведённая двум пациентам, была успешной. Предложенная методика показала высокую эффективность в восстановлении проходимости проксимальной части бульбарной уретры, бульбо-мембранозного отдела и зон сопоставления после ранее перенесенного бульбо-простатического анастомоза или радикальной простатэктомии. Special difficulties arise when the defect removed is more considerable (4–7 cm). In such cases it is difficult to perform an anastomosis without. The method was planned to be used in the patients who had previously undergone unsuccessful anastomotic operations, and the impossibility of their repeated execution; as well as with iatrogenic strictures of the the bulbomembranous part of the urethra to reduce the risk of incontinence and erectile dysfunction. We obtained the results demonstrating the possibility of using this method for a wider profile of patients with urethral strictures
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