Kulkarni Sanjay B, Barbagli Guido, Joshi Pankaj M, Hunter Craig, Shahrour Walid, Kulkarni Jyotsna, Sansalone Salvatore, Lazzeri Massimo
Kulkarni Reconstructive Urology Center, Pune, India.
Center for Reconstructive Urethral Surgery, Centro Chirurgico Toscano, Arezzo, Italy.
Urology. 2015 May;85(5):1200-1205. doi: 10.1016/j.urology.2014.12.055. Epub 2015 Mar 25.
To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective.
We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study. Anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique, and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed.
Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 patients (53.3%) were adults (19-49 years). The mean number of prior urethroplasties was 1.8 (range, 1-3). All patients underwent elaborated bulbomembranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients, 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow-up was 18 months (range, 13-24 months).
Combining a laparoscopic omentoplasty to a membranobulbar anastomosis for complex and redo pelvic fracture urethral injury is successful, feasible, safe, and with minimal additional morbidity to the patient. The technique has the advantage of a perineal incision and the ability to use the omentum to support the anastomosis.
验证一种新的手术技术的假设，即对于复杂且既往骨盆骨折尿道缺损修复失败的患者，采用精细的会阴吻合尿道成形术联合腹腔镜大网膜成形术是可行、安全且有效的。
我们进行了一项前瞻性、观察性的2a期研究，以观察2012年1月至2013年2月在印度浦那的一个中心采用会阴和腹腔镜联合入路进行尿道成形术治疗骨盆骨折尿道缺损患者的治疗效果。研究纳入骨盆骨折尿道损伤后出现复杂和再次手术的骨盆骨折尿道缺损患者。排除前尿道狭窄患者。主要研究结局是手术技术的成功率，次要结局是评估该手术的可行性和安全性。当术后需要任何器械操作时，临床结局被视为失败。
15例男性患者纳入研究，中位年龄19岁。7例患者为青少年（12 - 18岁），8例患者（53.3%）为成年人（19 - 49岁）。既往尿道成形术的平均次数为1.8次（范围1 - 3次）。所有患者均采用会阴入路进行精细的球膜部吻合，同时行耻骨下切除术，并联合腹腔镜将大网膜游离至会阴，包裹吻合口并填充会阴死腔。15例患者中，14例（93.3%）成功，1例（6.6%）失败。一名14岁的青少年男孩术后2个月出现复发性狭窄，采用尿道内切开术治疗。中位随访时间为18个月（范围13 - 24个月）。
对于复杂和再次手术的骨盆骨折尿道损伤，将腹腔镜大网膜成形术与球膜部吻合术相结合是成功、可行、安全的，且对患者的额外发病率极低。该技术具有会阴切口的优势以及利用大网膜支持吻合的能力。
