Maranya G A, Al-Ammary Y A, Oduor P R
Coast Province General Hospital, P.O. Box 91066-80103, Mombasa, Kenya.
East Afr Med J. 2007 Aug;84(8):356-62. doi: 10.4314/eamj.v84i8.9541.
To highlight the complexity of urethral injuries and to emphasise their prevention.
A retrospective study.
Coast Province General Hospital, Mombasa, Kenya.
Twenty two male patients operated between 1997 and 2007.
Surgery for urethral injuries was done on 22 patients; 16 were of the posterior urethra, five bulbar urethra and one proximal penile urethra. The posterior urethral injuries were due to: pelvic fracture in 14, penetrating stick in one, and one animal injury by a buffalo. The bulbar urethral injuries were due to straddle injuries in four and one gunshot injury. The penile urethral injury was by compression of the subject by a motor vehicle against a wall. Anastomotic urethroplasty was performed in 20 patients, of whom 16 had complete recovery. Surgery for all bulbar and the penile urethral injuries was successful. Failure of repair with restenosis occurred in four patients with posterior urethral injuries. Bouginage was done in one patient who subsequently required no further treatment. Eventual total obliteration occurred in three patients. Reoperation was done in two of these with complete recovery in one and failure in the other who had two further urethroplasties, optical urethrotomy and is currently on clean intermittent self catheterisation. The fourth patient awaits reoperation. Sutureless membranous urethroplasty was done in two patients with posterior urethral injuries in whom sutures could not be inserted into the proximal prostatic urethra. One developed stenosis a year later, had optical urethrotomy and commenced on clean intermittent self catheterisation for a while, without further trouble. The other developed total obliteration. At repeat surgery enhanced scarring with urethral shortening were found and the operation was abandoned. The Mitrofanoff principle was applied with an appendicovesicostomy; one form of urinary diversion with a continent catheterisable conduit. On follow up, now nine years, the diversion is continent, has no catheterisation difficulties, and no urinary calculi.
Urethral injuries are difficult to manage. A two pronged approach is advanced; prevention and competent repair. Surgeons managing these injuries are encouraged to acquire the needed reconstruction skills. Emphasis on prevention is paramount. Appropriate road, industrial and occupational safety measures should be enforced. Iatrogenic injuries can be avoided by due care during catheterisation and urethral instrumentation.
强调尿道损伤的复杂性并着重其预防。
一项回顾性研究。
肯尼亚蒙巴萨的海岸省总医院。
1997年至2007年间接受手术的22例男性患者。
对22例患者进行了尿道损伤手术；其中16例为后尿道损伤，5例为球部尿道损伤，1例为阴茎近端尿道损伤。后尿道损伤的原因如下：14例因骨盆骨折，1例因刺入的棍棒，1例因水牛致伤。球部尿道损伤的原因是4例骑跨伤和1例枪伤。阴茎尿道损伤是由于机动车将患者挤压在墙上所致。20例患者接受了吻合性尿道成形术，其中16例完全康复。所有球部和阴茎尿道损伤的手术均成功。4例后尿道损伤患者修复失败并出现再狭窄。1例患者接受了尿道扩张术，随后无需进一步治疗。3例患者最终出现完全闭塞。其中2例患者再次手术，1例完全康复，另1例失败，该患者又接受了两次尿道成形术、直视下尿道切开术，目前进行清洁间歇性自家导尿。第4例患者等待再次手术。2例后尿道损伤患者因无法将缝线插入前列腺近端尿道而进行了无缝线膜部尿道成形术。1例患者一年后出现狭窄，接受了直视下尿道切开术，并开始一段时间的清洁间歇性自家导尿，之后未再出现问题。另1例患者出现完全闭塞。再次手术时发现瘢痕增生并伴有尿道缩短，手术终止。采用了米氏原理进行阑尾膀胱造口术；这是一种可控性尿流改道的方式。随访9年后发现，这种尿流改道方式可控，无导尿困难，也无尿路结石。
尿道损伤难以处理。提出了双管齐下的方法；预防和进行有效的修复。鼓励处理这些损伤的外科医生掌握所需的重建技能。强调预防至关重要。应实施适当的道路、工业和职业安全措施。在导尿和尿道器械操作过程中，通过适当的护理可避免医源性损伤。
