Outcome of patients with failed pelvic fracture-associated urethral injury repair: A single centre 10-year experience.
Outcome of patients with failed pelvic fracture-associated urethral injury repair: A single centre 10-year experience.
复制标题
骨盆骨折相关尿道损伤修复失败患者的结果：单中心 10 年经验。
DOI：
10.5152/tud.2018.36824
复制
发表时间：
2019
影响因子：
1.3
通讯作者：
S. Sankhwar
中科院分区：
文献类型：
--
作者：
G. Garg;Manmeet Singh;M. Kumar;A. Aggarwal;Siddharth Pandey;Deepanshu Sharma;S. Sankhwar
客观化
骨盆骨折后再发后尿路狭窄的治疗是一项具有挑战性的任务。尽管有许多手术入路可用，但对于最佳入路还没有达成共识。本研究的目的是介绍我们10年来治疗因尿路感染引起的复发性尿路狭窄的经验。
材料和方法
我们采用描述性统计方法，对2006年1月至2016年12月间接受手术治疗的复发性后尿路狭窄患者进行了单机构回顾。我们只包括那些因先前失败的修复而接受了一些明确的外科手术的pfui患者(S)。
结果
最终分析包括50名男性患者(10名青少年和40名成年人)的数据。患者平均年龄29.92±10.62岁。狭窄平均长度为3.02±1.47 cm。40例行会渐进成形术(PPU)。2例合并直肠尿瘘/假道的患者接受了经耻骨尿道成形术(TPU)。对3例完全性球部坏死行单期/分期包皮管重建术。1例行前臂放射状游离皮瓣显微手术，2例行会会及阑尾膀胱Mitrofan of吻合术。大多数并发症是轻微的(Clavien 1级和2级)。PPU治疗总成功率为75%。平均随访29.46±10.68个月(13~60个月)。
结论
复发性后尿路狭窄长度<3 cm者，PPU手术成功率较高。复杂性和长节段(大于3 cm)狭窄需要使用辅助性手术，如TPU、替代尿路成形术和Mitrofan off阑尾卵巢吻合术。
OBJECTIVE
The management of recurrent posterior urethral strictures developing after pelvic fracture urethral injury (PFUI) is a challenging task. Despite availability of many surgical approaches, there is no consensus regarding the optimal approach. The objective of this study was to present our 10-year experience in the management of recurrent urethral strictures due to PFUI.
MATERIAL AND METHODS
We did a retrospective single-institution review of patients who underwent surgical management for recurrent posterior urethral strictures from January 2006 to December 2016 using descriptive statistics. We included only those patients with PFUI who underwent some definitive surgical procedure for their previous failed repair(s).
RESULTS
The final analysis included data of 50 male patients (10 adolescents and 40 adults). Mean age of the patients was 29.92±10.62 years. The average length of stricture was 3.02±1.47 cm. Progressive perineal urethroplasty (PPU) was done in 40 cases. Two patients with concomitant rectourethral fistula/false passage underwent transpubic urethroplasty (TPU). Three patients with complete bulbar necrosis were managed with single stage/staged preputial tube reconstruction. One patient underwent microsurgical urethroplasty using radial free forearm flap while in two patients each Mitrofanoff appendicovesicostomy and perineal urethrostomy was done. Majority of complications were minor (Clavien Grade 1 and 2). Overall success rate of PPU was 75%. Mean follow-up period was 29.46±10.68 months (range: 13-60 months).
CONCLUSION
Most cases of recurrent posterior urethral strictures of <3 cm in length can be operated by PPU with reasonable success rates. Complex and long-segment (higher than 3 cm) strictures require use of ancillary procedures like TPU, substitution urethroplasty and Mitrofanoff appendicovescostomy.