Horiguchi Akio, Shinchi Masayuki, Masunaga Ayako, Okubo Kazuki, Kawamura Kazuki, Ojima Kenichiro, Ito Keiichi, Asano Tomohiko, Azuma Ryuichi
Department of Urology, National Defense Medical College, Saitama, Japan.
Department of Urology, National Defense Medical College, Saitama, Japan.
Urology. 2017 Oct;108:184-189. doi: 10.1016/j.urology.2017.06.001. Epub 2017 Jun 9.
To compare the clinical courses of patients with pelvic fracture urethral injury (PFUI) according to initial management strategy.
We reviewed the clinical courses of 63 patients with PFUI who were initially treated elsewhere and underwent delayed anastomotic urethroplasty by a single surgeon between 2008 and 2015. Patients were grouped according to their initial treatment: by suprapubic tube placement alone (49 patients, SPT group) or primary realignment (14 patients, PR group). Time to urethroplasty was defined as the period between injury and delayed urethroplasty. Clinical data regarding the status of urethral stenosis, urethroplasty procedure, and treatment outcome were analyzed.
The mean time to urethroplasty in the PR group was about 3 times than that in the SPT group (133 months vs 47 months, P = .035). Fifty percent of the PR group (7 of 14) had a history of repeated urethrotomy or dilation before referral, a percentage significantly higher than that of the SPT group (20.4%, 10 of 49, P = .027). The percentage of patients having a false passage and iatrogenic scar was significantly higher in the PR group (42.9% vs 16.3%, P = .035), but there was no significant between-group difference in urethral stenosis length, operative time, operative blood loss, or the percentage of patients requiring inferior pubectomy or urethral rerouting.
PR does not facilitate delayed urethroplasty, and patients who undergo PR are at high risk of having a more complicated stenosis and longer time to urethroplasty, presumably because of repeated transurethral procedures.
根据初始治疗策略比较骨盆骨折尿道损伤（PFUI）患者的临床病程。
我们回顾了63例PFUI患者的临床病程，这些患者最初在其他地方接受治疗，并于2008年至2015年间由同一位外科医生进行了延迟吻合性尿道成形术。根据患者的初始治疗方法进行分组：仅行耻骨上造瘘管置入术（49例患者，耻骨上造瘘管组）或一期复位术（14例患者，一期复位组）。尿道成形术时间定义为损伤至延迟尿道成形术之间的时间段。分析了有关尿道狭窄状况、尿道成形术操作及治疗结果的临床数据。
一期复位组尿道成形术的平均时间约为耻骨上造瘘管组的3倍（133个月 vs 47个月，P = 0.035）。一期复位组50%（14例中的7例）患者在转诊前有反复尿道切开或扩张史，该比例显著高于耻骨上造瘘管组（20.4%，49例中的10例，P = 0.027）。一期复位组出现假道和医源性瘢痕的患者比例显著更高（42.9% vs 16.3%，P = 0.035），但两组在尿道狭窄长度、手术时间、术中失血量或需要行耻骨下切除术或尿道改道的患者比例方面无显著差异。
一期复位术不利于延迟尿道成形术，接受一期复位术的患者发生更复杂狭窄及尿道成形术时间更长的风险较高，推测是由于反复经尿道操作所致。
