Advertisement

Der Urologe

, Volume 44, Issue 7, pp 768–773 | Cite as

Komplizierte Harnröhrenrekonstruktionen bei Erwachsenen und Kindern

  • J. SeiboldEmail author
  • U. Nagele
  • K. D. Sievert
  • A. Stenzl
Leitthema

Zusammenfassung

Harnröhrenrekonstruktionen stellen bei Erwachsenen, jedoch bei Kindern und Jugendlichen umso mehr, eine Herausforderung an den Operateur dar. Exakte anatomische Kenntnisse (Blutversorgung des Penis und Verlauf der Nervenfasern) und die Handhabung von mikrochirurgischem Instrumentarium und Gebrauch von feinem Nahtmaterial verbesserten die Ergebnisse signifikant.

Zunehmende Kenntnisse eröffneten die Möglichkeit Harnröhrenstrikturen mit Transplantaten zu korrigieren. Wangenschleimhaut, derzeit die Schleimhaut der Wahl, führte zu einer deutlichen Verbesserung der Resultate.

In einer Studie kontrollierten wir unsere Ergebnisse von längerstreckigen, bulbären Harnröhrenrekonstruktionen mit Verwendung von Wangenschleimhaut. Zur Korrektur von koronaren oder subkoronaren Hypospadieformen führten wir eine Modifikation der Meatusmobilisation (MEMO) durch. Bei den Patienten mit einer langstreckigen Harnröhrenstriktur berichten wir eine Erfolgsrate von 91% mit einem Follow-up von im Durchschnitt 16 Monaten. Bei keinem der Kinder, die mit der MEMO-Technik operiert wurden, trat eine Komplikation (z. B. Fistel) auf bei einem mittleren Follow-up von 12,5 Monaten.

Schlüsselwörter

Harnröhrenrekonstruktion Bukkale Mukosa Distale Hypospadie 

Urethral reconstruction in the adult and in infant and young male patients

Abstract

The urethral reconstruction is a challenge in the adult, but even more in infant and young male patients. Good knowledge of the anatomy of the penis (blood supply and the course of the nerve fibers) with the availability of microsurgery suturing and instruments improved the outcome significantly.

The growing knowledge opened the possibility to reconstruct complicate strictures with grafts. The buccal mucosa flap is one of those improvements, which made a tremendous impact to have a successful outcome.

Recently we looked into the outcome of urethral reconstruction of long urethral strictures by using a buccal mucosa only flap. We used a modified technique for hypospadias repair to reconstruct coronar or subcoronar defects by meatal mobilization (MEMO). In cases with a long urethral stricture the success rate was over 90% with a mean follow up of 16 months. In all children the outcome with the MEMO-technique was successful without any major complication with a mean follow-up of 12.5 months.

Keywords

Urethral reconstruction Buccal mucosa Hypospadia repair 

Notes

Interessenkonflikt:

Keine Angaben

Literatur

  1. 1.
    Baskin LS, Duckett JW (1995) Buccal mucosa grafts in hypospadias surgery. Br J Urol 76(Suppl 3): 23–30Google Scholar
  2. 2.
    Humby G (1941) A one-stage operation for hypospadias. Br J Surg 29: 84Google Scholar
  3. 3.
    Barbagli G, Palminteri E, Rizzo M (1998) Dorsal onlay graft urethroplasty using penile skin or buccal mucosa in adult bulbourethral strictures. J Urol 160: 1307CrossRefPubMedGoogle Scholar
  4. 4.
    Morey AF, McAninch JW (1996) When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology 48: 194CrossRefPubMedGoogle Scholar
  5. 5.
    Pansadora V, Emiliozzi P, Gaffi M, Scarpone P (1999) Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol 161: 1501CrossRefPubMedGoogle Scholar
  6. 6.
    Duckett JW (1986) The use of buccal mucosa graft in epispadias. Society of Paediatric Urological Surgeons, Southhampton, UKGoogle Scholar
  7. 7.
    Elliott SP, Metro M, McAnninch JW (2003) Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol 169: 1754–1757CrossRefPubMedGoogle Scholar
  8. 8.
    Barbagli G, Palminteri E, Lazzeri M, Guazzoni G (2003) One-stage circumferential buccal mucosa graft urethroplasty for bulbous striature repair. Urology 60: 452–455CrossRefGoogle Scholar
  9. 9.
    Anema JG, Morey AF, McAninchJW et al. (2000) Complications related to the high lithotomy position during urethral reconstruction. J Urol 164: 360–363CrossRefPubMedGoogle Scholar
  10. 10.
    Miller KS, Leekwen P, Cowan RB et al. (1998) Neurologic complications of the exaggerated lithotomy position: detailed analysis. J Urol 159(Suppl): 1008Google Scholar
  11. 11.
    Mor Y, Ramon J, Jonas P (2000) Is only meatoplasty a legitimate surgical solution for extreme distal hypospadias? A long-term follow-up after adolescence. BJU Int 85: 501–503CrossRefPubMedGoogle Scholar
  12. 12.
    Oswald J, Korner I, Riccabona M (2000) Comparison of the perimeatal-based flap (Mathieu) and the tubularized incised-plate urethroplasty (Snodgrass) in primary distal hypospadias. BJU Int 85: 725–727CrossRefPubMedGoogle Scholar
  13. 13.
    Caione P, Capozzi N, Lais A, Matatazzo E (2000) Periurethral muscle complex reassembly for exstrophy-epispadias repair. J Urol 164: 2062–2066CrossRefPubMedGoogle Scholar
  14. 14.
    Surer I, Baker LA, Jeffs RD, Gearhart JP (2000) The modified Cantwell-Ransley repair for exstrophy and epispadias: 10 year experience. J Urol 164: 1040–1042CrossRefPubMedGoogle Scholar
  15. 15.
    Dodat H, Landry JL, Szwarc C, Culem S, Murat FJ, Dubois R (2003) Current opinion in urology. BJU Int 91: 528–531CrossRefPubMedGoogle Scholar
  16. 16.
    El-Kassaby AW, Fath-Alla M, Noweir AM, El-Halaby MR, Zakaria W, El-Beialy MH (1993) One-stage anterior urethroplasty. J Urol 149: 276PubMedGoogle Scholar
  17. 17.
    Barbagli G, Palminteri E, Lazzeri M, Guazzoni G (2003) Anterior urethral strictures. BJU Int 92: 497–505CrossRefPubMedGoogle Scholar
  18. 18.
    Cimador M, Castagnette M, De Grazia E (2003) Urethrocutaneous fistula repair after hypospadias surgery. BJU Int 92: 621–623CrossRefPubMedGoogle Scholar
  19. 19.
    Elbakry A (2003) Further experience with the tubularized-incised urethral plate technique for hypospadias repair. BJU Int 89: 291–294CrossRefGoogle Scholar
  20. 20.
    Baskin LS, Duckett JW, Ueoka K, Seibold J, Snyder HM (1994) Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol 151(1): 191–196PubMedGoogle Scholar
  21. 21.
    Fisch M (2004) Concepts for correction of penile hypospadias. Urologe A 43(4): 402–407CrossRefPubMedGoogle Scholar
  22. 22.
    Fichtner J, Flipas D, Fisch M, Hohenfellner R, Thüroff JW (2004) Long-term follow-up of buccal mucosa onlay graft for hypospadias repair: analysis of complications. J Urol 172: 1970–1972CrossRefPubMedGoogle Scholar
  23. 23.
    Baskin L (2001) Hypospadias: a critical analysis of cosmetic autcomes using photography. BJU Int 87: 534–539CrossRefPubMedGoogle Scholar
  24. 24.
    Samuel M, Capps S, Worthy A (2002) Distal hypospadias: which epair? BJU Int 90: 88–91CrossRefPubMedGoogle Scholar
  25. 25.
    Mitchell ME, Bägli DJ (1996) Complete penile disassembly for epispadias repair: the Mitchell technique. J Urol 155: 300–304CrossRefPubMedGoogle Scholar
  26. 26.
    Pippi-Salle JL, Jednak R, Capolicchio JP, Franca IMP, Labbie A, Gosalbez R (2002) A ventral rotational skin flap to improve cosmesis and avoid chordee recurrence in epispadias repair. BJU Int 90: 918–923CrossRefPubMedGoogle Scholar
  27. 27.
    Snodgrass W, Nguyen M (2002) Current technique of tubularized incised plate hypospadias repair. Urology 60(1): 157–162CrossRefPubMedGoogle Scholar
  28. 28.
    Snodgrass W, Koyle M, Manzoni G, Hurwitz R, Caliamone A, Ehrlich R (1996) Tubularized incised plate hypospadias repair: results of a multicenter experience. J Urol 156: 839–841CrossRefPubMedGoogle Scholar
  29. 29.
    Baskin LS, Erol A, Ying Wu L, Cunha G (1998) Anatomical studies of hypospadias. J Urol 160: 1108–1115CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  • J. Seibold
    • 1
    • 2
    Email author
  • U. Nagele
    • 1
  • K. D. Sievert
    • 1
  • A. Stenzl
    • 1
  1. 1.Klinik für UrologieUniversitätsklinikumTübingen
  2. 2.Klinik für UrologieUniversitätsklinikumTübingen

Personalised recommendations