Koraitim Mamdouh M
Department of Urology, College of Medicine, University of Alexandria, Alexandria, Egypt.
J Urol. 2009 Oct;182(4):1435-9. doi: 10.1016/j.juro.2009.06.022. Epub 2009 Aug 15.
We identified preoperative factors predictive of the appropriate surgical approach to anastomotic repair of pelvic fracture urethral distraction defects.
We reviewed the medical records and imaging studies of 121 patients who had undergone anastomotic repair of a pelvic fracture urethral distraction defect. The review was focused on 10 preoperative clinicoradiological variables that may influence or predict the surgical repair. The patients were categorized as having undergone a simple perineal operation (78 patients, group 1), or an elaborated perineal or a combined perineo-abdominal procedure (43 patients, group 2). Univariate and multivariate analyses were used to identify preoperative parameters predictive of the type of anastomotic repair. In addition, ROC analysis was used to assess prediction results of the multivariate analysis.
On univariate analysis 5 parameters were significant predictors of the type of repair, while on multivariate analysis only 3 parameters remained strong and independent predictors including the gapometry/urethrometry index, urethral gap length and prostatic displacement. The gapometry/urethrometry index was a proxy for all other parameters. At a cutoff index of 0.35 the appropriate surgical repair was predicted with 91% specificity and a 95% positive predictive value. When ROC analysis was performed the AUC was 0.979.
The type of anastomotic repair of pelvic fracture urethral distraction defect can be predicted by 3 preoperative factors, namely the gapometry/urethrometry index, urethral gap length and prostatic displacement. The gapometry/urethrometry index has the highest predictive accuracy and is a proxy for all other factors. An index less than 0.35 indicates a simple perineal operation and an index greater than 0.35 indicates an elaborated perineal or a transpubic procedure.
我们确定了术前因素，这些因素可预测骨盆骨折尿道牵张缺损吻合修复的合适手术方式。
我们回顾了121例接受骨盆骨折尿道牵张缺损吻合修复患者的病历和影像学研究。回顾聚焦于10个可能影响或预测手术修复的术前临床放射学变量。患者被分为接受简单会阴手术的（78例，第1组），或接受精细会阴手术或会阴 - 腹部联合手术的（43例，第2组）。采用单因素和多因素分析来确定可预测吻合修复类型的术前参数。此外，使用ROC分析评估多因素分析的预测结果。
单因素分析时，5个参数是修复类型的显著预测因素，而多因素分析时只有3个参数仍然是强有力的独立预测因素，包括尿道间距测量/尿道长度测量指数、尿道间隙长度和前列腺移位。尿道间距测量/尿道长度测量指数可代表所有其他参数。在临界指数为0.35时，预测合适手术修复的特异性为91%，阳性预测值为95%。进行ROC分析时，曲线下面积为0.979。
骨盆骨折尿道牵张缺损吻合修复的类型可通过3个术前因素预测，即尿道间距测量/尿道长度测量指数、尿道间隙长度和前列腺移位。尿道间距测量/尿道长度测量指数具有最高的预测准确性，并且可代表所有其他因素。指数小于0.35表明适合简单会阴手术，指数大于0.35表明适合精细会阴手术或经耻骨手术。
