早期复位对骨盆骨折后尿道损伤的长度和延迟修复的影响。

Effect of early realignment on length and delayed repair of postpelvic fracture urethral injury.

机构信息

Department of Urology, University of Alexandria Faculty of Medicine, Alexandria, Egypt.

出版信息

Urology. 2012 Apr;79(4):912-5. doi: 10.1016/j.urology.2011.11.054. Epub 2012 Feb 18.

DOI:10.1016/j.urology.2011.11.054

PMID:22342415

Abstract

OBJECTIVE

To determine the effect of early realignment of posterior urethral injury on the length and delayed repair of ensuing urethral defect.

METHODS

We reviewed the medical records of 120 patients with a pelvic fracture urethral defect who were referred for delayed repair from elsewhere from 1995 to 2009. The review was focused on 5 variables: initial management of urethral injury, length of urethral defect, type of delayed repair, continence, and erectile function. Of the patients, 26 were excluded from the study and 94 were categorized as having been initially treated by realignment (42 patients, group 1) or suprapubic cystostomy (52 patients, group 2).

RESULTS

Urethral defects ≤ 2 cm in length were found in 28 patients (67%) in group 1 versus 22 (42%) in group 2. Defects >2 cm were found in 14 patients (33%) in group 1 versus 30 (58%) in group 2. The repair was accomplished by a simple perineal operation in 32 (76%) and 30 (58%) patients in groups 1 and 2, respectively. An elaborated perineal or perineo-abdominal procedure was required in 10 (24%) and 22 (42%) patients in groups 1 and 2, respectively (all P < .05). Incontinence occurred in 1 patient in group 1. Impotence developed in 10 (28%) of 36 realigned adults and in 2 (5%) of 38 adults with suprapubic cystostomy.

CONCLUSION

Early realignment of posterior urethral injury decreases the length of the ensuing urethral defect and facilitates its delayed repair. Incontinence and impotence appear to result from the injury itself and not the treatment.

摘要

目的

确定早期矫正后尿道损伤对随后尿道缺损长度和延迟修复的影响。

方法

我们回顾了 1995 年至 2009 年期间因延迟修复而从其他地方转诊的 120 例骨盆骨折尿道缺损患者的病历。研究重点关注 5 个变量：尿道损伤的初始处理、尿道缺损长度、延迟修复类型、尿控和勃起功能。在患者中，有 26 例被排除在研究之外，94 例被分为接受过矫正（42 例，第 1 组）或耻骨上膀胱造口术（52 例，第 2 组）的初始治疗。

结果

第 1 组中有 28 例（67%）患者的尿道缺损长度≤2cm，第 2 组中有 22 例（42%）。第 1 组中有 14 例（33%）患者的缺损>2cm，第 2 组中有 30 例（58%）。第 1 组和第 2 组分别有 32 例（76%）和 30 例（58%）患者通过简单的会阴手术进行修复，分别有 10 例（24%）和 22 例（42%）患者需要进行复杂的会阴或会阴-腹部手术（均 P<0.05）。第 1 组中有 1 例患者发生尿失禁。36 例接受矫正的成年人中有 10 例（28%）发生勃起功能障碍，38 例接受耻骨上膀胱造口术的成年人中有 2 例（5%）发生勃起功能障碍。