Rekonstruktive Chirurgie der Harnröhre

Zusammenfassung

Urethrastrikturen können in jedem Lebensalter auftreten. Häufig entstehen sie iatrogen nach traumatischen Kathetereinlagen und transurethralen Eingriffen. Die endoskopische Schlitzung ist der einfachste, aber auch der mit den häufigsten Rezidiven behaftete operative Eingriff. Die retrograde Urethrografie bzw. Zysturethrografie spielt weiterhin eine zentrale Rolle in der Diagnostik und Therapieplanung. Eine einheitliche Vorgehensweise bzgl. der Operationstechnik, des perioperativen Managements und der postoperativen Verlaufskontrollen fehlt. Die genaue Kenntnis der Harnröhre und der urogenitalen Anatomie sind Voraussetzung für eine erfolgreiche urethrale Chirurgie. Die dauerhafte Beseitigung einer Striktur kann häufig nur durch offene rekonstruktive Eingriffe erreicht werden. Die End-zu-End-Harnröhrenplastik wird hierbei für kurze bulbäre Harnröhrenstrikturen angewendet, während die Harnröhrenplastik mit Mundschleimhaut im Fall von längeren bulbären und penilen Strikturen zum Einsatz kommt. Die Harnröhren-Rekonstruktion mit dem autologen patienteneigenen Zelltransplantat MukoCell^® ist eine schonende und vielversprechende Alternative zur herkömmlichen Transplantation mit nativer Mundschleimhaut. Die komplexen urethralen Rekonstruktionen sollten in Zentren mit entsprechender Expertise durchgeführt werden.

Abstract

Urethral strictures are independent of a patient’s age and can happen in every life period. They are often iatrogenic, resulting from a transurethral surgical procedure or traumatic catheterisation. Endoscopic slotting is the surgery of choice; although this method is frequently associated with recurrence.

Retrograde urethrography or cystourethrography continue to play a central role in diagnostic evaluation and treatment. There is no standardised procedure regarding the surgical technique, perioperative management, and postoperative follow-up. Evidence-based recommendations or guidelines do not exist.

For a successful surgical treatment of the urethra it is important to have an excellent knowledge of the urethral and urogenital anatomy.

The permanent removal of urethral strictures can only be achieved by open reconstructive surgery. Direct end-to-end urethroplasty is used, in general, for short bulbar urethral strictures, while urethroplasty with oral mucosa is used for longer bulbar and penile strictures.

Urethral reconstruction using a patient-specific autologous cell transplant with MukoCell^® is an alternative to the conventional transplantation with native oral mucosa.

Urethral reconstruction should be performed in specialised centres with appropriate expertise.

Schlüsselwörter

Harnröhrenenge - Harnröhrenstriktur - Harnröhrenplastik - Rekonstruktion

Key words

urethral stenosis - urethral stricture - urethroplasty - reconstruction

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