Hong Young-Kwon, Choi Kyung-Hwa, Lee Young-Tae, Lee Seung-Ryeol
Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Injury. 2017 May;48(5):1035-1039. doi: 10.1016/j.injury.2017.02.030. Epub 2017 Feb 27.
Internal urethrotomy (IU) in patients with urethral contracture following perineal repair of pelvic fracture urethral injuries (PRPFUI) is troublesome. We evaluated the clinical factors affecting the surgical outcome of IU for urethral contracture after PRPFUI.
We retrospectively reviewed the records of 35 patients who underwent IU for urethral contracture after PRPFUI between March 2004 and June 2013. Ages of patients ranged from 18 to 50, and their follow-up duration was more than 1year after IU. The urethral contracture was confirmed by retrograde urethrogram or cysto-urethroscopy. Success was defined as greater than 15mL/s of peak urinary flow rate at 1year after IU without any clinical evidence of urethral contracture. Success rates were investigated according to the number of IU. Age, body mass index, urethral defect length before PRPFUI, time interval between the original urethral injury and the PRPFUI or between a previous operation and the PRPFUI, time interval between the PRPFUI and the urethral contracture, number of PRPFUI performed, and the type of urethral lengthening procedure were compared between patients with and without success according to the number of IU.
Among the 35 patients, the overall success rate of IU was 37% (13/35) during the mean follow-up period of 53 months (range: 17-148 months). There were 8 and 5 patients with success in first and second IU, respectively. However, there was no success after third IU. Urethral defect length before PRPFUI was significantly shorter in patients with success who underwent first and second IU (p<0.05). There were significant differences of success between patients with and without previous repeated failures of PRPFUI in first and second IU (p<0.05).
Short urethral defect length and no previous surgical failures before PRPFUI are good prognostic factors for IU following PRPFUI. Only one or two IUs will be helpful in patients with urethral contracture following PRPFUI.
骨盆骨折尿道损伤会阴修补术（PRPFUI）后发生尿道狭窄的患者行尿道内切开术（IU）具有一定难度。我们评估了影响PRPFUI后尿道狭窄IU手术效果的临床因素。
我们回顾性分析了2004年3月至2013年6月间35例行PRPFUI后尿道狭窄IU手术患者的记录。患者年龄在18至50岁之间，IU术后随访时间超过1年。通过逆行尿道造影或膀胱尿道镜检查确诊尿道狭窄。成功定义为IU术后1年时最大尿流率大于15mL/s且无尿道狭窄的临床证据。根据IU次数调查成功率。比较首次、第二次IU成功和未成功患者的年龄、体重指数、PRPFUI前尿道缺损长度、初次尿道损伤与PRPFUI之间或上次手术与PRPFUI之间的时间间隔、PRPFUI与尿道狭窄之间的时间间隔、PRPFUI次数以及尿道延长手术类型。
35例患者中，平均随访53个月（范围：17 - 148个月）期间，IU的总体成功率为37%（13/35）。首次IU成功的有8例，第二次IU成功的有5例。然而，第三次IU后无成功病例。首次和第二次IU成功的患者PRPFUI前尿道缺损长度明显较短（p<0.05）。首次和第二次IU中，PRPFUI之前有或无反复手术失败的患者成功率存在显著差异（p<0.05）。
PRPFUI前尿道缺损长度短且既往无手术失败是PRPFUI后IU的良好预后因素。PRPFUI后尿道狭窄患者仅进行一两次IU可能有效。
