Dorairajan Lalgudi N, Gupta Harendra, Kumar Santosh
Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
BJU Int. 2004 Jul;94(1):134-6. doi: 10.1111/j.1464-4096.2004.04874.x.
To present our experience with four urethral injuries in females accompanying a pelvic fracture, managed with primary repair or realignment of the urethra.
There were three teenage girls and one adult (22 years old). All the patients had complete urethral injuries associated with a pelvic fracture from accidents. They were managed by immediate suprapubic cystostomy followed by repair or realignment of the urethra over a catheter on the same day. The catheter was removed after 3 weeks and a voiding cysto-urethrogram taken. Thereafter they were followed with regular urethral calibration.
All patients voided satisfactorily with a good stream; three were fully continent and the fourth had transient stress urinary incontinence. One patient needed dilatation at 2 months and another visual internal urethrotomy at 5 months. At a mean (range) follow-up of 33 (9-60) months all the patients had a normal voiding pattern and were continent; none developed vaginal stenosis.
Primary repair of the urethra, and if that is impossible, simple urethral realignment over a catheter, is the procedure of choice for managing female urethral injury associated with a pelvic fracture. The procedure has the additional advantage of reducing the risk of vaginal stenosis.
介绍我们对4例伴有骨盆骨折的女性尿道损伤患者采用尿道一期修复或复位治疗的经验。
患者包括3名青少年女性和1名成年人（22岁）。所有患者均因意外导致骨盆骨折并伴有完全性尿道损伤。她们均接受了急诊耻骨上膀胱造瘘术，随后于同一天在导尿管引导下进行尿道修复或复位。3周后拔除导尿管，并进行排尿性膀胱尿道造影。此后对她们进行定期尿道扩张术随访。
所有患者排尿顺畅，效果满意；3例完全控尿，第4例有短暂性压力性尿失禁。1例患者在2个月时需要进行尿道扩张，另1例在5个月时需要进行直视下尿道内切开术。平均（范围）随访33（9 - 60）个月时，所有患者排尿模式正常且控尿良好；均未出现阴道狭窄。
尿道一期修复，若无法进行一期修复，则在导尿管引导下进行简单的尿道复位，是治疗伴有骨盆骨折的女性尿道损伤的首选方法。该方法还有降低阴道狭窄风险的额外优势。
