| Objective:To compare the clinical efficacy and complications of lingual mucosa graft(LMG)urethroplasty and penile skin flap(PSF)urethroplasty in the repair of anterior urethral stricture,and to provide a surgical strategy for graft substitution urethroplasty.Methods:The clinical data of 52 patients with anterior urethral stricture admitted to the Second Hospital of Shanxi Medical University from April 2017 to February 2022 were retrospectively analyzed.Among them,35 patients underwent LMG urethroplasty and 17 patients underwent PSF urethroplasty.The age of the patient,etiology,course,stricture location and length of urethral stricture were collected.The choice of surgical procedure,postoperative maximum urinary flow rate(Qmax),complications,international index of erectile function score(IIEF-5 score)and stricture recurrence were followed up and analyzed.All patients were followed up for more than 1 year.The differences of preoperative and postoperative Qmax and IIEF-5 score between the different groups were compared and evaluated,as well as postoperative complications such as urinary fistula and urinary tract infection.Meanwhile,the complications of the oral donor site,such as slurring of speech,sensitivity disorders and numbness were recorded.Results:A total of 52 patients were included in this study,and all operations were completed successfully.The follow-up time was 12-71 months,with an average of(34.0±18.3)months.In the LMG group,35 patients had a preoperative Qmax of(4.7 ± 1.8)ml/s.The Qmax at the time of catheter removal,3 months,6 months,and 1 year after operation was significantly higher than that before operation(P<0.01).At 1 year after operation,the Qmax was(16.6 ± 3.0)ml/s.The IIEF-5 scores before and 1 year after operation were(16.6 ± 3.5)and(15.8 ± 3.7)respectively.And the difference was not statistically significant(P > 0.05).In the PSF group,17 patients had a preoperative Qmax of(5.4 ±2.0)ml/s.The Qmax at the time of catheter removal,3 months,6 months,and 1 year after operation was significantly higher than that before surgery operation(P<0.01).At 1year after operation,the Qmax was(17.2 ± 2.5)ml/s.The IIEF-5 scores before and 1year after operation were(17.4 ± 5.3)and(15.9 ± 5.1)respectively.And the difference was not statistically significant(P>0.05).During long-term follow-up(≥1 year),5patients(14.3%)in the LMG group experienced postoperative recurrence,with a long-term success rate of 85.7%.In the PSF group,3 patients(17.6%)experienced postoperative recurrence,with a long-term success rate of 82.4%.There was no significant difference in the successful rate between the two groups(P>0.05).In the LMG group,two cases of urethral fistula,three cases of postoperative infection,one case of painful penile erection were found.And four cases experienced micturition dribbling within 1 year after the operation.In the PSF group,one case of penile superficial necrosis,one case of angulation of penis and pain during erection,one case of penile hypoesthesia and one case of urethral diverticulum were found.All patients in the LMG group had different degrees of complications such as slurring of speech,sensitivity disorders and numbness in the oral donor site after the operation,but the symptoms gradually relieved as time goes on.The oral symptoms disappeared in most patients within 3 months.Conclusion:1.Graft substitution urethroplasty is a safe and effective surgical manner for anterior urethral stricture.During long-term follow-up,the success rates of lingual mucosa graft urethroplasty and penile skin flap urethroplasty are similar.The incidence of long-term complications after urethroplasty in LMG group and PSF group is relatively low;There is no significant effect on sexual function(erectile function)when patients underwent lingual mucosa graft urethroplasty and penile skin flap urethroplasty.Both lingual mucosa graft and penile skin flap are good urethral substitutes for urethroplasty.2.The lingual mucosa graft is relatively convenient to obtain substitute,and the length of available substitute is relatively long,which may be more suitable for the repair of long anterior urethral stricture,especially pan-urethral stricture.In clinical practice,the selection of urethral substitutes should be individualized according to the actual situation. |
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