Kulkarni Urethroplasty Center, Pune, India.
J Urol. 2010 Mar;183(3):1049-54. doi: 10.1016/j.juro.2009.11.045. Epub 2010 Jan 21.
We compared posterior urethral strictures after pelvic fracture urethral distraction defects in India and Italy.
We retrospectively analyzed the records of patients in India and Italy who underwent repair for posterior urethral stricture after pelvic fracture urethral distraction defect. We investigated etiology, emergency treatment type, the specialist involved in emergency treatment, the type of stricture resulting from trauma and primary repair, posterior urethroplasty techniques and results.
Of 255 patients with a median age of 33 years 117 (45.8%) and 138 (54.2%) were evaluated in India and Italy, respectively. In India the most common causes of pelvic fracture urethral distraction defects were pedestrian (35%), motorcycle (26.5%) and bicycle (12.8%) accidents. The most common emergency treatment was suprapubic cystostomy (79.5% of cases). Of the patients 70.1% were treated in emergency fashion by a surgeon and 85.4% had complex posterior urethral strictures. The most common technique was anastomosis with inferior and total pubectomy in 56.4% and 15.3% of cases, respectively. In Italy the etiology was mainly automobile accidents (39.2%). The most common emergency treatment was endoscopic realignment (49.2% of cases). Of the patients 92.7% were treated in emergency fashion by a urologist and 68.1% had simple urethral strictures. Perineal anastomosis and laser urethrotomy were the most used techniques (38.4% and 21.1% of cases, respectively). In India 92 cases (78.6%) were successful and 25 (21.4%) failed while in Italy 120 (86.9%) were successful and 18 (13.1%) failed. Median followup was 74 months (range 12 to 239).
Differences in emergency treatment for pelvic fracture urethral distraction defects influence the choice of delayed posterior repair and results.
我们比较了印度和意大利骨盆骨折后尿道牵引缺损所致后尿道狭窄的情况。
我们回顾性分析了印度和意大利骨盆骨折后尿道牵引缺损后行后尿道狭窄修复的患者的病历。我们调查了病因、急救治疗类型、参与急救的专家、创伤引起的狭窄类型和初次修复、后尿道成形术技术和结果。
255 例患者的中位年龄为 33 岁，其中 117 例（45.8%）和 138 例（54.2%）分别在印度和意大利进行了评估。在印度，骨盆骨折后尿道牵引缺损最常见的原因是行人（35%）、摩托车（26.5%）和自行车（12.8%）事故。最常见的急救治疗是耻骨上膀胱造口术（79.5%的病例）。70.1%的患者在急诊时由外科医生治疗，85.4%的患者存在复杂后尿道狭窄。最常见的技术是吻合术，其中 56.4%和 15.3%的病例采用下和全耻骨切除术。在意大利，病因主要是汽车事故（39.2%）。最常见的急救治疗是内镜整复术（49.2%的病例）。92.7%的患者在急诊时由泌尿科医生治疗，68.1%的患者存在单纯性尿道狭窄。会阴吻合术和激光尿道切开术是最常用的技术（分别为 38.4%和 21.1%的病例）。在印度，92 例（78.6%）成功，25 例（21.4%）失败；而在意大利，120 例（86.9%）成功，18 例（13.1%）失败。中位随访时间为 74 个月（范围 12 至 239 个月）。
骨盆骨折后尿道牵引缺损的急救处理方式的差异影响了延迟后尿道修复的选择和结果。
