Application of 3D printing combined with intraoperative ultrasound navigation in the diagnosis and treatment of urethral strictures in the bulbar and membranous regions
Objective To explore the application of 3D printing combined with intraoperative ultrasound navigation in the clinical diagnosis and treatment of male urethral stricture in the bulbar region.Methods A retrospective analysis was conducted on the clinical data of 16 male patients with bulbar and membranous urethral strictures admitted to our hospital from August 2022 to December 2023.Age range of the patients was from 53 to 74 years old,with an average of(60±5.1)years old.Among them,there were 9 cases of bulbar stenosis and 7 cases of membranous stenosis.The causes of urethral stricture covered straddle injury(6 cases),iatrogenic injury(3 cases),and pelvic fracture(7 cases).A history of urethral stricture ranged from 9 months to 8 years,with an average of(35±21.9)months;The patient underwent a total of 4～38 transurethral incisions or expansions under direct vision,with an average of(8.4±2.6)times;Before surgery,urethral endoscopy,urethral imaging,and urethral 3D printing were performed to evaluate the stenotic segment of the urethra.The length of the urethral stenotic segment was 2.0～3.2 cm,with an average of(2.6±0.3)cm.All patients underwent suprapubic cystostomy one month prior to admission and received transperineal urethral end-to-end anastomosis.Results The location,degree,and length of urethral stricture of the patients were clearly defined using preoperative 3D urethral printing,in agreement with the intraoperative findings.All the patients underwent surgery successfully,with a surgical time of 72～139 minutes and an average of(92±16.7)minutes.There were no occurrences of urethral rectal fistula or urethral skin fistula during the perioperative period,and no cases of blood transfusion.One case had incision infection with a significant amount of secretion,which was treated with compression to remove the secretions below the incision,and the wound was healed after 2 weeks of dressing change.All patients'urinary catheters were removed 3～4 weeks after surgery.Among them,one patient with bulbous urethral stricture developed urethral meatus stenosis after removing the catheter,and urination usually occurred after three rounds of urethral dilation.The patients were followed up for 4～17 months,with an average of(9.5±3.6)months.All patients had smooth urination,with a maximum urine flow rate of 18.3～31.6 mL/s and an average of(22.9±3.1)mL/s.Urethral angiography or cystoscopy showed unobstructed urethral lumen.Conclusion The combination of 3D printing and intraoperative ultrasound navigation has important value in the diagnosis and treatment of male patients with bulbar urethral stricture;Preoperative 3D urethral printing can accurately diagnose the location,degree,and length of urethral stricture;Intraoperative ultrasound navigation can clarify the proximal position of urethral stricture and its relationship with the rectum,which is beneficial for quickly removing scar tissue around the proximal end of urethral stricture and effectively avoiding the occurrence of serious complications such as rectal injury.
3D printingultrasonographyend to end anastomosisurethral strictures in the bulbar and membranous regions
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