Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Bulbar Üretra Darlıklarının Tedavisinde Uç Uca Anastomoz Üretroplasti Sonuçlarımız
The Outcome of Surgical Excision and End-to-End Anastomosis Procedure in Our Cases with Bulbar Urethral Strictures
Hüseyin AYDEMİRa, Osman KÖSEa
aSakarya Üniversitesi Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, Sakarya, TÜRKİYE
J Reconstr Urol. 2020;10(1):1-6
doi: 10.5336/urology.2019-72635
Article Language: TR
Full Text
ÖZET
 Amaç: Bulbar üretra darlıklarında perineal üretroplasti uygulamaları altın standart tedavi yöntemidir. Biz bu çalışmada, bulbar üretra darlığı tanısı olan hastalarda tek bir cerrah tarafından yapılan uç uca anastomoz perineal üretroplasti sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Kliniğimizde Ocak 2014 ile Mayıs 2019 tarihleri arasında, bulbar üretra darlığı tanısı ile uç uca anastomozla tek aşamalı perineal üretroplasti yapılan 26 erkek hastanın sonuçları retrospektif olarak değerlendirildi. Tüm hastalarda operasyon öncesinde üroflowmetri ve retrograd üretrografi ile değerlendirme yapıldı. Preoperatif ve postoperatif maksimum akış hızı (Qmax) ve postmiksiyonel rezidü miktarı, darlık lokalizasyonu ve uzunluğu, eşlik eden hastalıklar, sigara kullanımı gibi veriler kayıt edildi. Komorbiditenin tanım ve derecelendirilmesi için Charlson komorbidite indeksi kullanıldı. Postoperatif aynı lokalizasyonda darlık için herhangi bir enstrümantasyon gerekliliği tedavi başarısızlığı olarak kabul edildi. Bulgular: Hastaların ortalama yaşı 61,60±15,10 yıl idi. Ortanca takip süresi 14 (3-56) ay idi. En sık etiyolojik faktör %84,61 oranında iyatrojenik nedenlerdi. Etiyolojide 3 (%11,54) hastada travma öyküsü, ve 1 (%3,85) hastada ise enfeksiyon vardı. Ortalama darlık uzunluğu 15,26±6,23 (5-25) mm idi. Ortalama ameliyat süresi 105,96±16,97 dk idi. Yedi (%26,92) hastada nüks darlık görüldü. Takip süresi boyunca genel başarı oranı %73,10 idi. Sonuç: Uç uca anastomoz ile tek aşamalı üretroplasti tekniği, yüksek başarı ve düşük komplikasyon oranlarına sahiptir. Preoperatif ve peroperatif değerlendirmeler ile uygun hasta seçimi başarı oranını yükseltecektir.

Anahtar Kelimeler: Anastomoz; cerrahi; üretra; üretra darlığı
ABSTRACT
 Objective: Perineal urethroplasty is the gold Standard treatment procedure in cases with bulbar urethral strictures. In this study, we aimed to evaluate the outcome of end-to-end anastomosis perineal urethroplasty procedure performed by a single surgeon in patients with bulbar urethral stricture. Material and Methods: We retrospectively evaluated the results of 26 male patients who underwent single-stage perineal urethroplasty by surgical excision and end-toend anastomosis between January 2014-May 2019 for bulbar urethral stricture. Preoperative uroflowmetry and retrograde urethrography were performed in all patients. Preoperative and postoperative maximum flow rate (Qmax) and postvoid residual volume, localization and length of urethral stricture, concomitant diseases, and smoking were recorded. Charlson comorbidity index was used for the definition and grading of comorbidity. In the postoperative period, the necessity of any instrumentation for stricture in the same location was accepted as treatment failure. Results: The mean age of the patients was 61.60±15.10 years. The median follow-up period was 14 (3-56) months. The most common etiologic factor was iatrogenic causes (84.61%). The etiology of stricture was trauma in 3 (11.54%) patients and infection in 1 (3.85%) patient. The mean stricture length was 15.26±6.23 (5-25) mm. The mean operation duration time was 105.96±16.97 minutes. Strictures recurred in 7 (26.92%) patients. The overall success rate was 73.10% during the follow-up period. Conclusion: Single-stage urethroplasty with end-to-end anastomosis has a high success rate and low complication rates. Appropriate patient selection by preoperative and perioperative evaluations increases the procedural success rate.

Keywords: Anastomosis; surgical; urethral; urethral stricture
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