Application of perineal ring-shaped flap at first stage anastomosis in treatment of urinary continence anterior urethral defect in female patients with urethral carcinoma / 第二军医大学学报

ABSTRACT

Objective To investigate the feasibility and efficacy of the first stage anastomosis using perineal ring-shaped flap in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma. Methods Tweenty-nine female patients with early urethra malignant tumor diagnosed in Changhai Hospital, Second Military Medical University from Jan. 2013 to Jan. 2016 were enrolled in this study. The average age of the patients was (61.4±14.4) years old, the clinical stages were type and the lesions were limited to half of the urethra. All patients underwent bladder-preserving urinary continence anterior urethral resection. After the resection of tumor, a free 30-40 mm long ring-shaped flap from the perineal vestibule was anastomosed inline to the end of the urethra. The clinical feasibility and safety of the operation were evaluated. Results The operation time was 0.45-1.50 h, with an average of (0.51±0.30) h. The postoperative urethral orifice shape of patients was close to the physiological shape with unobstructed urination, and the maximum urination rate was 12.8-33.0 mL/s, with an average of (19.3±8.7) mL/s. The success rate of one-stage operation was 100%, without any urethral stricture or urinary incontinence. All patients were followed up for 12-48 months with an average of (32.6±3.5) months. During follow-up, 1 case (1/6) with squamous cell carcinoma had a positive left inguinal lymph node metastasis in the first 2 years after surgery, and died of extensive lung metastasis 3 years after surgery; 1 case diagnosed with metastatic squamous cell carcinoma by postoperative pathological report developed regional swollen lymph nodes in the groin 13 months after surgery, and then ilioinguinal lymphadenectomy was perform to dissect the lymph nodes. No other recurrence was found during follow-up. Conclusion The first stage anastomosis surgury using perineal ring-shaped flap is safe and effective in the treatment of anterior urethral defect after bladder-preserving urinary continence anterior urethral resection in female patients with early urethra carcinoma.