Elberg J J, Lassen M K, Poulsen H, Nissen H M
Odense Sygehus, Urologisk Afdeling og Plastikkirurgisk Afdeling.
Ugeskr Laeger. 1990 Apr 23;152(17):1219-22.
In cases where there is clinical suspicion of urethral lesion, blind urethral catheterization should never be performed. Establishment of a suprapubic catheter is a safe and adequate primary treatment. Retrograde urethrography may be undertaken in the subsequent diagnostic process and, in cases of simple contusions without interruption of continuity, urethral catheterization is performed. In addition, intravenous urography should be undertaken to reveal possible simultaneous lesions of the upper urinary tract. Anterior lesions rarely require further treatment whereas posterior lesions with interruption of continuity should be treated in specialized departments with special expertise in this type of lesion. Partial ruptures frequently heal without stricture formation requiring treatment. In cases of complete rupture, the best results, as regards development of late sequelae, are obtained by delayed reconstruction carried out three to four months after the trauma in the form of a two-stage operation employing a perineal skin-flap and secondary reanastomosis. In all types of urethral lesion, control miction-cystourethrography is recommended one year after the final treatment on account of the risk of stricture formation.
对于临床上怀疑有尿道损伤的病例，绝不应进行盲目尿道插管。耻骨上膀胱造瘘是一种安全且充分的初始治疗方法。在后续诊断过程中可进行逆行尿道造影，对于单纯挫伤且连续性未中断的病例，可进行尿道插管。此外，应进行静脉尿路造影以发现上尿路可能同时存在的损伤。前尿道损伤很少需要进一步治疗，而后尿道连续性中断的损伤应在对此类损伤有专业特长的专科进行治疗。部分破裂通常可自愈，无需形成狭窄而进行治疗。在完全破裂的病例中，就后期后遗症的发生而言，通过在创伤后三到四个月进行延迟重建可获得最佳结果，采用会阴皮瓣和二期再吻合的两阶段手术形式。在所有类型的尿道损伤中，由于存在狭窄形成的风险，建议在最终治疗一年后进行排尿性膀胱尿道造影检查。
