Biserte J, Nivet J
Service d'urologie, hôpital Claude Huriez, CHRU Lille, rue Michel-Polonovski, 59037 Lille, France.
Ann Urol (Paris). 2006 Aug;40(4):220-32. doi: 10.1016/j.anuro.2006.05.002.
Injuries to anterior urethra are uncommon, mainly due to blunt trauma, and rarely associated with pelvic fractures or life threatening multiple lesions. Straddle type injury is the most frequent lesion, in which the immobile bulbar urethra is crushed or compressed on the inferior surface to the pubic symphysis. Diagnosis of urethral injury is easy, suspected due to trauma circumstances, presence of urethrorragy or initial hematuria, and eventually difficult micturition and penile scrotal for perineoscrotal hematoma. It should always be confirmed and classified by retrograde urethro-gram, realized either immediately or after a few days. Initial acute management is suprapubic cystostomy, if possible before any attempt of urethral catheterization or miction. Urethral contusions only require this urinary diversion or urethral catheter for a few days and usually heal without any sequelae. Management of partial and complete disruptions remains controversial: suprapubic diversion only and secondary endoscopic or open surgical repair of the urethral stricture that occurs in the great majority of the cases (always after complete disruption), early endoscopic realignment and prolonged urethral catheterization (4 for 8 weeks according to the lesion), in partial disruptions, more controversial in complete disruptions; delayed (after a few days) open surgical repair (urethrorraphy) that is the preferred European and French attitude for complete disruptions. Penetrating anterior urethral trauma and urethral lesions associated with penile fracture require immediate surgical exploration and repair if possible. After anterior urethral disruption, the main morbidity is urethral stricture very often requiring surgical treatment (visual urethrotomy if the structure is short, end to end spatulated urethrorraphy, flap or graft urethroplasty if longer).
前尿道损伤并不常见，主要由钝性创伤引起，很少与骨盆骨折或危及生命的多发损伤相关。骑跨伤是最常见的损伤类型，在此类损伤中，固定的球部尿道在耻骨联合下表面受到挤压或压迫。尿道损伤的诊断并不困难，根据外伤情况、尿道滴血或初始血尿以及最终出现排尿困难和阴茎阴囊或会阴阴囊血肿可怀疑尿道损伤。最终应通过逆行尿道造影进行确诊和分型，造影可立即进行或在数天后进行。初始急性处理是耻骨上膀胱造瘘术，如有可能应在尝试尿道插管或排尿之前进行。尿道挫伤仅需进行这种尿液转流或留置尿道导管数天，通常可无后遗症地愈合。部分和完全断裂的处理仍存在争议：仅进行耻骨上转流，对绝大多数病例（完全断裂后总是如此）出现的尿道狭窄进行二期内镜或开放手术修复；早期内镜复位和长时间留置尿道导管（根据损伤情况留置4至8周），部分断裂时采用这种方法，完全断裂时更具争议；延迟（数天后）开放手术修复（尿道吻合术），这是欧洲和法国处理完全断裂时首选的方法。穿透性前尿道创伤以及与阴茎骨折相关的尿道损伤，如有可能应立即进行手术探查和修复。前尿道断裂后，主要的并发症是尿道狭窄，通常需要手术治疗（如果狭窄段较短则行直视下尿道内切开术，如果较长则行端端斜行吻合尿道吻合术、皮瓣或移植尿道成形术）。
