Urethral reconstruction using buccal mucosa urethroplasty in the treatment of urethral injury

Abstract

52歳男性.患者は, 自慰行為による異物挿入での尿道損傷で受診となった.尿溢流とそれに伴う感染により陰茎は約1.5倍に腫脹, 自潰していた.異物除去とデブリードマンをまず施行し, その後は狭窄となった部に対して内尿道切開を施行した.感染消失を確認後は, 尿道と陰茎の再建を行ない, 遊離皮弁として口腔粘膜を摘出し, パッチを当てるように吸収糸による結節縫合で尿道欠損部に補填した.その結果, 良好な排尿が確保され, 現在まで合併症は認められていない

A 52-year-old Japanese man was referred to us with a urethral injury caused by masturbation. His penis was swollen and about one and a half times its size due to urine extravasation and infection. Foreign bodies were surgically removed, and debridement and excision of necrotic tissue were performed. After confirming that the infection was under control, we planned the reconstruction of the urethra and penis, following endoscopic urethrotomy for the bulbous urethra stricture. A free graft from the buccal mucosa was harvested, placed over the defect and fixed with interrupted suture as ventral onlay. The patient could achieve satisfactory voiding and no complication was seen during the 18-month follow up. In our experience, buccal mucosa is a useful source of urethral grafting material and excellent results can be expected in case of urethral injury.