Comparative anatomical study of three surgical approaches for treating complex posterior urethral stricture

Abstract

Abstract: Objective To evaluate the advantages and disadvantages of 3 surgical approaches via superior intermedial margin of the pubis, inferior medial margin of the pubis, and the perineum, respectively, in the treatment of posterior urethral stricture.Methods Thirty-five adult male corpses were disse cted in which the distances from the bulbo-membranous urethra conjuction (D), th e apex of prostate (E), and the bladder neck (F) to the superior medial margin of the pubis (A), the inferior medial mar-gin of the pubis (B) and the midpoint of linear distance between the two ischial tuberosities on the perineum (C) were respec-tively measured and compared. Another 20 adult male corpses were subjected to the 3 surgical approaches as described above and the urethra was exposed to identify the tissues and organs with possible injuries resulted from the surgery, which were e-valuated by scoring.Results The distances measured were as fol lows:AD=6.5±0.5cm, BD=2.2±0.5cm, CD =3.4±0.6cm, and BD<CD<AD (P=0.05, SN K means); AE=6.6±0.5cm, BE=3.0±0.5cm, CE=4.4±0.7cm,and BE<CE<AE (P=0.05, SNKmeans); AF=5.7±0.6cm, BF=4.5±0.5cm, CF=6.5±0.6cm, and BF<AF<CF (P=0.0 5,SNK means). The angles∠EAD (α₁ )=(9.3±2.0) o,∠EBD (α₂)=(17.4±3.8) o,∠ECD(α₃)=(9.2±1.6) o,showing marked difference between α₁ and α₂ (P<0.05, t=11.1) and between α₃ and α₂(P<0.05, t=12.1), but not between α₁ and α₃(P>0.05, t=0.13). The angles ∠FAE (β₁)=(22.7±2.6)°,∠FBE (β₂)=(32.9±6.4)°,∠FCE (β₃ )=(15.0±3.2)°,and β₂>β₁>β₃(P=0.05, SNK means). The score for tissue and organ injuries for the appro ach of the superior medial margin of the pubis was 13, 20 for the approach of in ferior medial margin of the pubis, and 15 for perineum approach.Conclusions In terms of operative field exposure, the best operation approach is via the infer i-or pubis, followed by superior pubis approach and perineum approach; while in view of the injuries, superior pubis approach is better than the perineum and i nferior pubis approaches. The inferior pubis approach should be the primary choi ce in the treatment of posterior urethral stricture.

CLC Number:

R695

ZHANG Xiao-ming¹, HE Hui-xu¹, HU Wei-lie¹, Lǚ Jun¹, NIE Hai-bo¹, LI Zhong-hua², LI Qing-rong¹, HUANG Xi-ao-ting¹, WANG Yuan-li¹, CAO Qi-you¹, YAO. Comparative anatomical study of three surgical approaches for treating complex posterior urethral stricture[J]. Journal of Southern Medical University, 2004, 24(01): 94-96.

References

[1] 程军平,戴景兴,刘永谦,等.前列腺解剖位置观察及经直肠局部药物注射治疗慢性前列腺炎临床分析[J].第一军医大学学报,2003,23(6):633-5.Cheng JP,Dai JX,Liu YQ,et al. Anatomic observation of the prostate for clinical application of local drug injection through the rectum for chronic prostatitis[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2003,23(6):633-5.
[2] Golimbu M,Al-Askair S,Morales P. Transpubic approach for lower urinary tract surgery:a 15-yeara experience[J]. J Urol,1990,143(1):72-6.
[3] 胡卫列,何恢绪,曹启友,等.U形多孔引流支架管在复杂性后尿道手术中的应用[J].第一军医大学学报,2003,23(9):932-3.Hu WL,He HX,Cao QY,et al. Application ofmultihole U-shaped drainage stent in complex posterior urethra surgery[J]. J First Mil Med Univ/Di Yi Jun Yi Da Xue Xue Bao,2003,23(9):932-3.
[4] Andrich DE,Mundy AR. Urethral strictures and their surgical treatment[J]. Bri J Urol,2000,86(5):571-80.
[5] 何恢绪,吕军,李清荣,等.耻骨下部分切除修复复杂性外伤性后尿道闭锁(附6例报告)[J].中华泌尿外科杂志,1997,18(6):365-7.He HX,Lu Jun,Li QR,et al. Partial pubectomy for repair of complicated posterior urethral obliteration (report of 6 cases)[J]. Chin J Urol,1997,18(6):365-7.
[6] 何恢绪,许家汉,李清荣,等.套人隔离法修补复杂后尿道直肠瘘(附11例报告)[J].中华泌尿外科杂志,2000,21(4):552-4.He HX,Xu JH,Li QR,et al. Repair of complicated posterior urethra-rectal fistula with the use of pull-through technique (report of 11cases)[J]. Chin J Urol,2000,21(4):552-4.
[7] 聂海波,何恢绪,胡卫列,等.肉膜蒂皮瓣治疗复杂性后尿道闭锁15年经验(附32例报告)[J].中华泌尿外科杂志,2003,24(6):406-8.Nie HB,He HX,Hu WL,et al. Experiences ofdartos island skin flap in 1-stage urethroplasty for complex posterior urethral obliteration in fifteen years (report of 32 cases)[J]. Chin J Urol,2003,24(6):406-8.