骨盆骨折尿道损伤患者初次内镜下尿道复位的非预期负面后果。

Unintended negative consequences of primary endoscopic realignment for men with pelvic fracture urethral injuries.

机构信息

Department of Urology, UT Southwestern Medical Center, Dallas, Texas.

出版信息

J Urol. 2014 Dec;192(6):1720-4. doi: 10.1016/j.juro.2014.06.069. Epub 2014 Jun 24.

DOI:10.1016/j.juro.2014.06.069

PMID:24972309

Abstract

PURPOSE

We evaluated the clinical course of patients with pelvic fracture urethral injury referred to our institution to elucidate the differences between initial management strategies.

MATERIALS AND METHODS

We retrospectively reviewed our institutional review board approved, prospectively maintained urethroplasty database from 2007 to 2013. Patients with pelvic fracture urethral injury were stratified into 2 groups based on initial treatment before referral. Group 1 (21 of 38, 55%) was treated with suprapubic tube placement alone followed by elective bulbomembranous anastomotic urethroplasty and group 2 (17 of 38, 45%) underwent early primary endoscopic realignment. We recorded the number of endoscopic interventions and time from injury to successful definitive treatment. Data regarding stricture length, reconstruction technique and treatment outcomes were analyzed.

RESULTS

Among 766 urethroplasties performed during the study interval 38 (5%) consecutive pelvic fracture urethral injury cases were identified with complete information available and all underwent repair with excision with primary anastomosis. For suprapubic tube/bulbomembranous anastomotic urethroplasty cases the mean time to definitive resolution of stenosis was dramatically shorter (7 months, range 3 to 15) compared to primary endoscopic realignment cases (122 months, range 4 to 574; p <0.01). The majority of patients treated with primary endoscopic realignment required multiple endoscopic urethral interventions (median 4, range 1 to 36; p <0.01) and/or experienced various other adverse events which were rarely noted in the suprapubic tube/bulbomembranous anastomotic urethroplasty group (14 of 17 [82%] vs 2 of 21 [10%], p <0.05).

CONCLUSIONS

Treatment of pelvic fracture urethral disruption injuries with primary endoscopic realignment appears to be associated with unintended negative consequences including additional interventions and a prolonged clinical course.

摘要

目的

我们评估了就诊于我院的骨盆骨折尿道损伤患者的临床病程，以阐明初始治疗策略之间的差异。

材料与方法

我们回顾性地分析了我院 2007 年至 2013 年经机构审查委员会批准并前瞻性维护的尿道成形术数据库。根据转诊前的初始治疗，将骨盆骨折尿道损伤患者分为 2 组。第 1 组（38 例中的 21 例，55%）接受单纯耻骨上管置管，随后择期行球部膜部吻合尿道成形术，第 2 组（38 例中的 17 例，45%）行早期经内镜直接复位。我们记录了内镜干预次数和从损伤到成功确定性治疗的时间。分析了狭窄长度、重建技术和治疗结果的数据。

结果

在研究期间进行的 766 例尿道成形术中，有 38 例（5%）连续骨盆骨折尿道损伤病例获得完整信息，所有患者均采用切除吻合术进行修复。对于耻骨上管/球部膜部吻合尿道成形术病例，狭窄确定性解决的平均时间明显缩短（7 个月，范围 3 至 15 个月），与经内镜直接复位病例相比（122 个月，范围 4 至 574 个月；p<0.01）。大多数接受经内镜直接复位治疗的患者需要多次内镜尿道干预（中位数 4 次，范围 1 至 36 次；p<0.01），并且/或者经历了各种其他不良事件，而这些事件在耻骨上管/球部膜部吻合尿道成形术组中很少见（17 例中的 14 例[82%]与 21 例中的 2 例[10%]相比，p<0.05）。