Ku Ja Hyeon, Jeon Youn Soo, Kim Min Eui, Lee Nam Kyu, Park Young Ho
Department of Urology, Military Manpower Administration, Taejeon, Korea.
Urol Int. 2002;69(3):227-32. doi: 10.1159/000063947.
We retrospectively reviewed the records of patients with traumatic posterior urethral injuries, analyzed postoperative findings to compare the results of the primary mode of management, and evaluated whether the Colapinto and McCallum classification system was valuable for predicting the complications.
55 patients with traumatic posterior urethral injuries were included in the study. A total of 35 patients underwent immediate realignment over a Foley catheter including direct Foley catheter insertion (group 1) and 20 underwent initial suprapubic tube placement followed by delayed urethroplasty (group 2). Urethral injuries were interpreted using the Colapinto and McCallum classification based on the retrograde urethrographies.
44 (80.0%) of the patients were classified to type III in both groups (group 1, 29 [82.9%]; group 2, 15 [75.0%]). Of group 1, mild, moderate and severe urethral strictures developed in 7 (20.0%), 8 (22.9%) and 6 (17.1%), respectively, and developed in 6 (30.0%), 2 (10.0%) and 5 (25.0%), respectively, of group 2. Six (17.1%) and 2 (20.0%) had decreased potency and 4 (11.5%) and 1 (5.0%) were impotent in group 1 and 2, respectively. Of group 1, incontinence developed in 3 patients but 1 did not need treatment, and developed in 2 (10.0%) but 1 (5.0%) did not need treatment of group 2. The score test for trend demonstrated that there were no significant differences of these results.
Our findings suggest that complications in patients with posterior urethral injuries are not related to the primary mode of management. Because most injuries are type III, the evolution toward the classification system is needed.
我们回顾性分析了创伤性后尿道损伤患者的病历，分析术后结果以比较主要治疗方式的效果，并评估科拉平托（Colapinto）和麦卡勒姆（McCallum）分类系统对预测并发症是否有价值。
本研究纳入55例创伤性后尿道损伤患者。其中35例患者通过Foley导尿管立即进行尿道会师复位，包括直接插入Foley导尿管（第1组），20例患者先行耻骨上膀胱造瘘管置入，随后延迟行尿道成形术（第2组）。根据逆行尿道造影结果，采用科拉平托和麦卡勒姆分类法对尿道损伤进行评估。
两组中44例（80.0%）患者被分类为Ⅲ型（第1组29例[82.9%]；第2组15例[75.0%]）。第1组中，轻度、中度和重度尿道狭窄分别发生7例（20.0%）、8例（22.9%）和6例（17.1%），第2组分别发生6例（30.0%）、2例（10.0%）和5例（25.0%）。第1组6例（17.1%）和2例（20.0%）出现性功能减退，第2组分别为4例（11.5%）和1例（5.0%）出现阳痿。第1组3例患者出现尿失禁，但1例无需治疗，第2组2例（10.0%）出现尿失禁，但1例（5.0%）无需治疗。趋势评分检验表明，这些结果无显著差异。
我们的研究结果表明，后尿道损伤患者的并发症与主要治疗方式无关。由于大多数损伤为Ⅲ型，因此需要改进分类系统。
