Department of Urology, Christian Medical College, Vellore, 632004, India.
World J Urol. 2011 Feb;29(1):97-101. doi: 10.1007/s00345-010-0524-8. Epub 2010 Mar 5.
To predict the outcome of redo-urethroplasty after failed single or multiple open urethral procedures for pelvic fracture urethral distraction defects.
From January 1997 to December 2006, 43 patients underwent redo-urethroplasty for pelvic fracture urethral distraction defect. Forty-one were referred from other centers. All had undergone open surgery along with an endoscopic procedure (one or more procedures in each patient) which included endoscopic internal urethrotomy, urethral stenting or urethral dilations.
There were 43 men with mean age of 29 (range 11-52). Eleven had associated injuries: intraperitoneal bladder rupture (3), bladder neck (2), rectum (3), anal sphincter (2), combined bladder, rectum and anal sphincter (1). Trocar suprapubic cystostomy was performed in 22, rail-road procedures in 10 and open suprapubic cystostomy in 11 along with the management of associated injuries as immediate treatment. Of 43 patients, 28 had progressive perineal, and 12 had transpubic repair. Three patients had total bulbar necrosis, and they underwent prepuceal tube reconstruction (1) and staged substitution with BMG and standard scrotal inlay (2). Analysis of various factors like number of attempts at previous surgery and stricture length did not affect the outcome. A successful result was achieved in 36 (83.72%), improved and stable in five and failure in two.
The overall result of redo-urethroplasty for pelvic fracture urethral distraction defect continues to be gratifying. Failures happen usually within the first 3 months. Substitution urethroplasty can be reserved for those who have long distraction defect. Long-term follow-up is essential using stringent criteria to measure success.
预测骨盆骨折尿道断裂缺陷患者行多次单一或多次开放性尿道手术失败后的尿道再修复术的结果。
1997 年 1 月至 2006 年 12 月，43 例骨盆骨折尿道断裂缺陷患者接受尿道再修复术。其中 41 例来自其他中心。所有患者均接受开放性手术和内镜手术（每位患者进行一次或多次手术），包括内镜尿道内切开术、尿道支架置入术或尿道扩张术。
43 例患者均为男性，平均年龄 29 岁（范围 11-52 岁）。11 例合并其他损伤：腹腔内膀胱破裂（3 例）、膀胱颈部（2 例）、直肠（3 例）、肛门括约肌（2 例）、膀胱、直肠和肛门括约肌联合损伤（1 例）。22 例行经皮耻骨上膀胱造瘘术，10 例行轨道式手术，11 例行开放性耻骨上膀胱造瘘术，同时处理合并损伤作为即时治疗。43 例患者中，28 例有进展性会阴损伤，12 例有经耻骨修复。3 例患者发生完全球部坏死，其中 1 例行包皮管重建，2 例行 BMG 和标准阴囊皮瓣分期替代。分析既往手术次数和狭窄长度等各种因素均未影响结果。36 例（83.72%）患者获得成功，5 例改善稳定，2 例失败。
骨盆骨折尿道断裂缺陷患者行尿道再修复术的总体效果仍令人满意。失败通常发生在术后 3 个月内。对于存在较长尿道断裂缺陷的患者，可以保留替代尿道成形术。采用严格的标准进行长期随访对于评估手术效果非常重要。
