Horiguchi Akio, Azuma Ryuichi, Tasaki Shinsuke, Hamada Shinsuke, Kuroda Kenji, Sato Akinori, Asakuma Junichi, Seguchi Kenji, Hayakawa Masamichi, Ito Keiichi, Asano Tomohiko
Department of Urology, National Defense Medical College, Saitama, Japan.
Nihon Hinyokika Gakkai Zasshi. 2013 Jul;104(4):589-97. doi: 10.5980/jpnjurol.104.589.
Salvage urethroplasty after failed repair of traumatic urethral injury is a urological challenge, and we herein describe our experience with it.
From October 2010 to January 2012, five patients underwent salvage repair of failed urethroplasties for traumatic urethral injuries: three bulbar straddle injuries and two pelvic fracture urethral injuries. One of the three failed urethroplasties for bulbar straddle injuries was a stricture excision and primary anastomosis, and its failure was due to periurethral abscess formation. Another was an augmented anastomotic urethroplasty using buccal mucosa, and its failure was due to periurethral abscess formation. The third was a tube graft urethroplasty using buccal mucosa, and its failure was due to a stricture at the anastomotic site. Two failed urethroplasties for pelvic fracture urethral injuries were perineal anastomotic repairs combined with corporal separation and inferior pubectomy, and the failures of both were due to ischemic bulbar necrosis. The urethral gap lengths estimated from urethrograms ranged from 12 to 45 mm (mean = 26 mm).
Urethroplasties in all patients with bulbar straddle injuries were salvaged by stricture excision and primary anastomosis with corporal separation, and urethroplasties in both patients with pelvic fracture urethral injuries were salvaged by abdominal transpubic perineal urethroplasty. Although the patients who underwent transpubic urethroplasty had transient pelvic girdle pain, no severe complications were observed. All patients were for 10 to 25 months postoperatively (mean = 16 months) able to void satisfactorily without additional treatment.
Failed urethroplasties for traumatic urethral injuries can be salvaged with a second reconstruction surgery. The procedure of choice for this salvage is anastomotic urethroplasty with techniques for tension-free anastomosis.
外伤性尿道损伤修复失败后的挽救性尿道成形术是一项泌尿外科挑战，我们在此描述我们在此方面的经验。
2010年10月至2012年1月，5例患者接受了外伤性尿道损伤修复失败后的挽救性修复：3例球部骑跨伤和2例骨盆骨折尿道损伤。3例球部骑跨伤修复失败的患者中，1例为狭窄切除及一期吻合术，其失败原因是尿道周围脓肿形成。另1例为使用颊黏膜的扩大吻合性尿道成形术，其失败原因是尿道周围脓肿形成。第3例为使用颊黏膜的管状移植尿道成形术，其失败原因是吻合口狭窄。2例骨盆骨折尿道损伤修复失败的患者为会阴吻合修复联合阴茎海绵体分离及耻骨下切除术，两者失败原因均为球部缺血性坏死。根据尿道造影估计的尿道缺损长度为12至45毫米（平均=26毫米）。
所有球部骑跨伤患者均通过狭窄切除及一期吻合联合阴茎海绵体分离进行了挽救性尿道成形术，2例骨盆骨折尿道损伤患者均通过经腹耻骨后会阴尿道成形术进行了挽救性尿道成形术。尽管接受耻骨后尿道成形术的患者有短暂的骨盆带疼痛，但未观察到严重并发症。所有患者术后10至25个月（平均=16个月）均能满意排尿，无需额外治疗。
外伤性尿道损伤修复失败后可通过二次重建手术进行挽救。这种挽救的首选手术是采用无张力吻合技术的吻合性尿道成形术。
