Straddle injuries to the bulbar urethra: management and outcome in 53 patients
Straddle injuries to the bulbar urethra: management and outcome in 53 patients
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DOI：
10.1590/s1677-55382009000400009
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发表时间：
2009-08-01
影响因子：
3.7
通讯作者：
Elgammal, Mohammed Abd-Alla
中科院分区：
文献类型：
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作者：
Elgammal, Mohammed Abd-Alla
目的：描述我们的经验与钝性损伤的球尿道及其晚期后遗症，以确定可能影响患者outcome.Materials和方法的因素：一项回顾性研究，对53例男性患者谁提出，2001年1月至2005年12月，钝性创伤性损伤的球尿道。尿道断裂的明确诊断是通过逆行尿道造影，其中尿道断裂分为部分或完全。最短随访期为3年。最初的治疗是耻骨上膀胱造口术或内窥镜下尿道导管上的尿道重新排列，使用膀胱镜通过导丝插入导管。对于可通过的狭窄，通过可视尿道内切开术（VIU）和尿道成形术（狭窄切除和再吻合）处理VIU后无法通过的狭窄或复发。随访期为3年。结果：22例完全性尿道断裂中19例（86%）发生尿道断裂，31例部分性尿道断裂中10例（32%）发生尿道断裂（P < 0.001）。耻骨上膀胱造口术组31例中有11例（35%）发生尿道狭窄，初次尿道会师组22例中有18例（82%）发生尿道狭窄（P < 0.001）。结论：耻骨上膀胱造瘘术是治疗骑跨性球部尿道损伤的一种较好的方法，其成功率为15%（4/26例），而尿道成形术成功率为96%（24/25例）。尿道切除再吻合术是治疗膀胱尿道骑跨伤后狭窄的较好方法。
Objective: To describe our experience with blunt injuries to the bulbar urethra and their late sequelae to identify factors that may affect patient outcome.Materials and Methods: A retrospective study was performed on 53 male patients who presented, between January 2001 and December 2005, with blunt traumatic injury to the bulbar urethra. The definitive diagnosis of urethral rupture was made by retrograde urethrography, where urethral rupture was classified into partial or complete. The minimum follow-up period was 3 years. The initial management was either suprapubic cystostomy or endoscopic urethral realignment over a urethral catheter using a cystoscope to pass a guide-wire over which the catheter was inserted. Stricture formation was managed by visual internal urethrotomy (VIU) for passable strictures and urethroplasty (stricture excision and re-anastomosis) for impassable strictures or recurrence after VIU. The follow-up period was three years. The results were analyzed by SPSS software (chi-square and Student's-t-test).Results: Stricture formation occurred in 19 of 22 patients (86%) with complete urethral rupture and in 10 of 31 (32%) with partial rupture (p < 0.001). Strictures occurred in 11 of 31 (35%) patients treated initially with suprapubic cystostomy and in 18 of 22 (82%) treated with primary urethral realignment (p < 0.001). The success rate after VIU was 15% (4 of 26 patients) and after urethroplasty it was 96% (24 of 25 patients) (p < 0.001).Conclusions: Suprapubic eystostomy is better than urethral realignment and catheterization as primary management after straddle injury to the bulbar urethra. Stricture excision and re-anastomosis is better than VIU as delayed management for strictures that develop after straddle injury to the bulbar urethra.