REPAIR THE OLD FASHIONED DEFECT OF
POST URETHRA WITH BLADDER MUCOSA (8 CASES) DEPARTMENT OF PEDIATRIC UROLOGY
SURGERY
Xia ZT, Lu WP, Yang GW
Shanghai children’s Hospital, China
It is very difficult to repair children’s old fashioned-rupture of
urethra, especially the longer defect caused by trauma. The operation may be difficult and
there is usually an unsatisfied result. We had tried the approach that reconstructed severely
damaged urethra with bladder mucosa.
Material:
We chose cases of trauma-caused urethrostenosis or urethratresia from 1989
to 1998. The defect arranged
from 2cm to 5cm. Age: 4~12yrs;
Gender: Male. All these
patients were operated 1 to 3 times, and went with Pelvis fracture and
scar. There were sinus of
urethra. 2 cases are damaged
in bladder and other organs, and other 2 cases were attended by VUR (II)
and infection of urinary tract.
We made urethrography with contrast medion going through the entry
of sinus of threthra and urethra.
We found that the defect of urethra was in a range of 2cm to 5cm
without expand of proximal end.
We also found that was almost urthratrasia in most uretha according
to urethrography.
Method of Operation: The incision was made in perineum. The scar and urthratresia must be
removed. A piece of bladder
mucoumembrand (7cm × 2.5cm) was
made. Then it was cured by
attaching to a stent (Poly Silicone Cannulation, F12~F14#). The conducted material was passed
through bladder. The rapture
urethra was insulated from end to end.
Results:
All patients tried to micturate after removing the stent 3 or 5 weeks after
operation. There are 6
patients needed several dilatation and electro-cut. 2 patients needed once or twice
dilatation. They all obtained
good micturation after those procedure.
Discussion:
The surgical procedure was maily used to repair a trauma-caused old
fashioned urethrostenosis and urethratresia. The end-to-end anastomosis is one of the efficient
therapies of defect of urethra.
There is not enough length of urethra that could be used, because of
shortness of the children’s urethra.
It is more difficult than adults to make a good end-to-end
anastomosis without tension.
We used to repair the defect of urethra or hypospadisa with bladder
mucous membrane. It goes
satisfied. The rebuilded urethra
made from bladder mucous membrane could be very stable with urine. But it is a couple due to tissue
around post urethra. The scar
after pressing the rebuilded urethra, and it becomes narrowed (such as
Dancing-like Narrow) again.
Therefore, we rebuild the wall of the urethra with cascutarite
scratemma around the bladder mucous membrane. Such could reduce the dead-space, and the scar could be
repaired. This surgical
procedure could be used to child shoes urethra has a long defect. This operation is somehow simple to
do, and the effect is very good.
It is a method we strongly recommend.