Bulbar ve panüretral darlığı olan erkek hastalarda bukkal mukoza greft üretroplasti tedavisinin sonuçları

Yıl 2022, Cilt: 3 Sayı: 2, 66 - 70, 25.08.2022

Adem Emrah Coğuplugil , Sercan Yılmaz , Turgay Ebiloğlu , Selcuk Sarıkaya , Doğucan Nuri Uğur , Bahadır Topuz , Mesut Gurdal

https://doi.org/10.29228/anatoljhr.62900

Öz

Amaç: Bulbar ve panüretral darlığı olan erkek hastalarda bukkal (yanak) mukozal greft (BMG) üretroplasti tedavi sonuçlarını sunmak ve ayrıca darlık nüksü ile ilişkili faktörleri belirlemek.
Yöntem: Üretra darlığı nedeniyle BMG üretroplasti uygulanan erkek hastalar geriye dönük olarak incelendi. Başarı, maksimum işeme hızında >15mL/s ile işeme olarak tanımlandı. Darlık nüksü varsa sistoüretrografi ve üretroskopi yapıldı. Başarı oranı, darlık nüksü ve diğer komplikasyonlar analiz edildi.
Bulgular: 24 erkek hasta tespit edildi. Bulbar darlık için 12 hastaya BMG üretroplasti ve panüretral darlık için 12 hastaya BMG üretroplasti uygulandı. Ortalama 18 aylık takipte başarı oranı %79 idi. Bulbar darlığı olan hastalarda başarı oranı %75, panüretral darlığı olan hastalarda ise %83 idi. Toplamda 5 hastada darlık nüksü gelişti. Darlık nüks oranı ile darlık uzunluğu arasında istatistiksel olarak anlamlı bir ilişki bulunamadı. Tüm nüksler daha önce ≥3 internal üretrotomi geçirmiş hastalarda meydana geldi. Önceki internal üretrotomi prosedürünün sayısı, darlık nüksü ile önemli ölçüde ilişkiliydi.
Sonuçlar: Bukkal mukoza greft üretroplasti hem bulbar hem de panüretral darlıklarda etkili bir tedvi yöntemidir. Önceki internal üretrotomi prosedürünün sayısı, darlık nüksü ile önemli ölçüde ilişkilidir. İlk internal üretrotomi başarısızlığından sonra hastalara bukkal mukoza greft üretroplastisi önerilmelidir.

Anahtar Kelimeler

yanak mukozası, erkek, üretra darlığı

Treatment outcomes of buccal mucosa graft urethroplasty in male patients with bulbar and panurethral strictures

Öz

Aim: To present the treatment outcomes of buccal mucosal graft (BMG) urethroplasty in male patients with bulbar and panurethral strictures and also to identify the factors associated with stricture recurrence.
Methods: Male patients who underwent BMG urethroplasty for anterior urethral strictures were reviewed retrospectively. Success was defined as a voiding with >15mL/s in maximal voiding velocity. If stricture recurrence occured, cystourethrography and urethroscopy were performed. Success rate, stricture recurrence and other complications were analyzed.
Results: 24 male patients were identified. 12 patients underwent BMG urethroplasty for bulbar stricture and 12 patients underwent BMG urethroplasty for panurethral stricture. Success rate was 79% at a mean 18 months follow up. Success rate was 75% in patients with bulbar stricture and 83% in patients with panurethral stricture. In total, 5 patients developed stricture recurrence. No statistically significant association was found between stricture recurrence rate and stricture length. All of the recurrences were occurred in patients who underwent ≥3 previous internal urethrotomies. The number of previous internal urethrotomy procedure was significantly associated with stricture recurrence.
Conclusion: Buccal mucosa graft urethroplasty is effective in both bulbar and panurethral strictures. The number of previous internal urethrotomy procedure is significantly associated with stricture recurrence. Buccal mucosa graft urethroplasty should be offered to the patients after first internal urethrotomy failure.

Anahtar Kelimeler

buccal mucosa, male, urethral stenosis

Kaynakça

• Al-Hakeem, Y., Chung,. A, Chung, B., & Tse, V. (2019). Substitution urethroplasty for the treatment of male urethral stricture: Outcomes in an Australian center. Lower Urinary Tract Symptoms, 11(4), 211-216. https://dx.doi.org/10.1111/luts.12265
• Asopa, H. S., Garg, M., Singhal, G. G., Singh, L., Asopa, J., & Nischal, A. (2001). Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology, 58(5), 657-659. https://dx.doi.org/10.1016/s0090-4295(01)01377-2
• Barbagli, G. (2004). When and how to use buccal mucosa grafts in penile and bulbar urethroplasty. Minerva Urology and Nephrology, 56(2), 189-203.
• Barbagli, G., Montorsi, F., Balò, S., Sansalone, S., Loreto, C., Butnaru, D., Bini, V., & Lazzeri, M. (2019). Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results. World Journal of Urology, 37(6), 1165-1171. https://dx.doi.org/10.1007/s00345-018-2481-6
• Breyer, B. N., McAninch, J. W., Whitson, J. M., Eisenberg, M. L., Mehdizadeh, J. F., Myers, J. B., & Voelzke, B. B. (2010). Multivariate analysis of risk factors for long-term urethroplasty outcome. Journal of Urology, 183(2), 613-617. https://dx.doi.org/10.1016/j.juro.2009.10.018
• Chapple, C., Andrich, D., Atala, A., Barbagli, G., Cavalcanti, A., Kulkarni, S., Mangera, A., & Nakajima, Y. (2014). SIU/ICUD consultation on urethral strictures: The management of anterior urethral stricture disease using substitution urethroplasty. Urology, 83(3 Suppl), 31-47. https://dx.doi.org/10.1016/j.urology.2013.09.012
• Dubey, D., Vijjan, V., Kapoor, R., Srivastava, A., Mandhani, A., Kumar, A., & Ansari, M. S. (2007). Dorsal onlay buccal mucosa versus penile skin flap urethroplasty for anterior urethral strictures: results from a randomized prospective trial. Journal of Urology, 178(6), 2466-2469. https://dx.doi.org/10.1016/j.juro.2007.08.010
• Furr, J. R., Wisenbaugh, E. S., & Gelman, J. (2019). Urinary and sexual outcomes following bulbar urethroplasty-an analysis of 2 common approaches. Urology, 130, 162-166. https://dx.doi.org/10.1016/j.urology.2019.02.042
• Horiguchi, A. (2017). Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews. International Journal of Urology, 24(7), 493-503. https://dx.doi.org/ 10.1111/iju.13356
• Kessler, T. M., Schreiter, F., Kralidis, G., Heitz, M., Olianas, R., & Fisch, M. (2003). Long-term results of surgery for urethral stricture: a statistical analysis. Journal of Urology, 170(3), 840-844. https://dx.doi.org/10.1097/01.ju.0000080842.99332.94
• Kulkarni, S., Barbagli, G., Sansalone, S., & Lazzeri, M. (2009). One-sided anterior urethroplasty: a new dorsal onlay graft technique. British Journal of Urology International, 104(8), 1150-1155. https://dx.doi.org/10.1111/j.1464-410X.2009.08590.x
• Kulkarni, S., Kulkarni, J., Surana, S., & Joshi, P. M. (2017). Management of Panurethral Stricture. Urology Clinics of North America, 44(1), 67-75. https://dx.doi.org/10.1016/j.ucl.2016.08.011
• Levy, M. E., & Elliott, S. P. (2017). Graft use in bulbar urethroplasty. Urology Clinics of North America, 44(1), 39-47. https://dx.doi.org/10.1016/j.ucl.2016.08.009
• McKibben, M. J., Davenport, M. T., Mukherjee, P., Shakir, N. A., West, M. L., Fuchs, J. S., Ward, E. E., Bergeson, R. L., Scott, J. M., & Morey, A. F. (2020). Outpatient buccal mucosal graft urethroplasty outcomes are comparable to inpatient procedures. Translational Andrology and Urology, 9(1), 16-22. https://dx.doi.org/10.21037/tau.2019.08.29
• Mundy, A. R., & Andrich, D. E. (2011). Urethral strictures. British Journal of Urology International, 107(1), 6-26. https://dx.doi.org/10.1111/j.1464-410X.2010.09800.x
• Patterson, J. M., & Chapple, C. R. (2008). Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. European Urology, 53(6), 1162-1171. https://dx.doi.org/10.1016/j.eururo.2007.10.011
• Pisapati, V. L., Paturi, S., Bethu, S., Jada, S., Chilumu, R., Devraj, R., Reddy, B., & Sriramoju, V. (2009). Dorsal buccal mucosal graft urethroplasty for anterior urethral stricture by Asopa technique. European Urology, 56(1), 201-205. https://dx.doi.org/10.1016/j.eururo.2008.06.002
• Santucci, R., & Eisenberg, L. (2010). Urethrotomy has a much lower success rate than previously reported. Journal of Urology, 183(5), 1859-62. https://dx.doi.org/10.1016/j.juro.2010.01.020
• Soave, A., Kluth, L., Dahlem, R., Rohwer, A., Rink, M., Reiss, P., ... & Engel, O. (2019). Outcome of buccal mucosa graft urethroplasty: a detailed analysis of success, morbidity and quality of life in a contemporary patient cohort at a referral center. BMC Urology, 19(1), 1-6.
• Verla, W., Waterloos, M., Spinoit, A. F., Oosterlinck, W., & Lumen, N. (2020). Independent risk factors for failure after anterior urethroplasty: a multivariate analysis on prospective data. World Journal of Urology, 38(12), 3251-3259. https://dx.doi.org/10.1007/s00345-020-03123-0
• Wessells, H., Angermeier, K. W., Elliott, S., Gonzalez, C. M., Kodama, R., Peterson, A. C., Reston, J., Rourke, K., Stoffel, J. T., Vanni, A. J., Voelzke, B. B., Zhao, L., & Santucci, R. A. (2017). Male urethral stricture: American Urological Association Guideline. Journal of Urology, 197(1), 182-190. https://dx.doi.org/10.1016/j.juro.2016.07.087
• Yalçınkaya, F., & Kartal, I. (2020). Critical analysis of urethroplasty for male anterior urethral stricture: a single-center experience. World Journal of Urology, 38(9), 2313-2319. https://dx.doi.org/10.1007/s00345-019-03014-z
• Zimmerman, W. B., & Santucci, R. A. (2011). Buccal mucosa urethroplasty for adult urethral strictures. Indian Journal of Urology, 27(3), 364-370. https://dx.doi.org/10.4103/0970-1591.85441