Turner-Warwick R
Middlesex Hospital, London, England.
Urol Clin North Am. 1989 May;16(2):335-58.
Times have changed, and urology is not what it was: it is no longer possible for any urologist to be an in-depth expert in more than one or two of its many expanding subspecialist fields--such as pediatric, oncology, reconstruction and functional restoration, stone surgery, gynecourology, neuropathic urinary tract dysfunction, transplantation, fertility, and andrology, etc. Although some techniques for the resolution of urethral strictures, such as dilatation and internal urethrotomy, can be regarded as general urologic procedures, the problems involved in definitive urethral reconstruction should never be underestimated. The potentially complicated nature of a pelvic fracture urethral injury is entirely apparent. It is particularly important to appreciate that an apparently short subprostatic stricture cannot be reliably identified preoperatively as 'simple' and consequently appropriate for a simple perineal approach repair; any surgical failure to resolve a urethral distraction defect inevitably complicates it and may even preclude a subsequent anastomotic retrievoplasty. Thus, surgeons with a general urologic training who do not have both a special additional and ongoing experience of reconstructive procedures and a particular aptitude for the problems involved must be advised that "having a go" is not in the best interests of their patients. The prevention of complications is the essence of good surgery and is essentially a personal matter because many contrarily conceived procedures work quite satisfactorily in the hands of others: consequently, many of the views expressed in this communication are essentially personal, and references to personal publications are made to substantiate statements. However, no one is more conscious than I am of the contributions of friends and colleagues across the world who are interested in the most intriguing field of functional reconstruction, and I am also particularly grateful to the many who have most generously referred their patients and thus created the series on which this article is based.
时代在变，泌尿外科今非昔比：如今，任何泌尿外科医生都不可能在其众多不断拓展的亚专科领域中成为一两个以上领域的深度专家，这些领域包括小儿泌尿外科、肿瘤泌尿外科、重建与功能修复、结石手术、妇科泌尿学、神经源性尿路功能障碍、移植、生殖医学以及男科等等。虽然一些治疗尿道狭窄的技术，如扩张术和尿道内切开术，可被视为普通泌尿外科手术，但绝不能低估确定性尿道重建所涉及的问题。骨盆骨折尿道损伤潜在的复杂性是显而易见的。尤其重要的是要认识到，术前不能可靠地将明显较短的前列腺下尿道狭窄认定为“简单”狭窄，因此适合采用简单的会阴入路修复；任何未能解决尿道牵张缺损的手术都会不可避免地使其复杂化，甚至可能妨碍随后的吻合修复术。因此，对于那些接受过普通泌尿外科培训，但既没有重建手术的特殊额外且持续经验，又没有处理相关问题的特殊能力的外科医生，必须告知他们“尝试一下”并非对患者最有利。预防并发症是优秀手术的关键，本质上是个人的事情，因为许多构思相反的手术在其他人手中也能取得相当满意的效果：因此，本交流中表达的许多观点本质上是个人观点，引用个人出版物是为了证实陈述。然而，没有人比我更清楚世界各地对功能重建这一最具吸引力领域感兴趣的朋友和同事所做出的贡献，我也特别感谢许多人极其慷慨地转诊他们的患者，从而促成了本文所基于的系列病例。
