Devine C J, Jordan G H, Devine P C
Department of Urology, Eastern Virginia Medical School, Norfolk.
Urol Clin North Am. 1989 May;16(2):291-5.
Urethral scarring resulting in stricture formation can be avoided or minimized by proper treatment after injury. On presentation of the trauma patient, the possibility of such injury must be suspected and the urethra evaluated prior to any attempts at catheter placement. Diversion in all cases of posterior urethral injury should be by a suprapubic tube, with any urinary extravasation drained at the site of the injury. If the patient's general condition allows it, the disrupted urethra should be realigned by a catheter after the puboprostatic ligaments have been divided. These measures allow the prostate to return to the urogenital diaphragm without tension and in line with the distal urethra. Until the prostate is released, no amount of traction will reapproximate the urethra, and after it is released, traction is not necessary. The suprapubic catheter provides diversion, preventing further complications caused by urinary extravasation; urethral alignment minimizes subsequent stricture formation. When the stricture develops, if it is urodynamically significant, it can be repaired in 4 to 6 months. If one is fortunate, the stricture will be short and amenable to internal urethrotomy. If not, open reconstruction will be greatly facilitated by the attempts to guide the distracted ends of the urethra together.
损伤后通过适当治疗可避免或尽量减少导致尿道狭窄形成的尿道瘢痕。在创伤患者就诊时，必须怀疑有此类损伤的可能性，并在尝试放置导尿管之前对尿道进行评估。所有后尿道损伤病例均应通过耻骨上造瘘管进行尿液改道，并在损伤部位引流任何尿液外渗。如果患者的一般情况允许，在耻骨前列腺韧带切断后，应通过导尿管使断裂的尿道重新对合。这些措施可使前列腺无张力地回到尿生殖膈，并与尿道远端对齐。在前列腺松解之前，任何程度的牵引都无法使尿道重新接近，而在松解之后，牵引则没有必要。耻骨上导尿管提供尿液改道，防止尿液外渗引起进一步并发症；尿道对合可最大限度地减少随后的狭窄形成。当狭窄形成时，如果其在尿动力学上具有重要意义，可在4至6个月内进行修复。如果幸运的话，狭窄将很短且适合进行尿道内切开术。如果不行，尝试将尿道离断端引导在一起将极大地便于进行开放重建。
