Barros R, Silva Mis, Antonucci V, Schulze L, Koifman L, Favorito L A
Souza Aguiar Hospital Municipal and State University , Rio de Janeiro , Brazil.
Ann R Coll Surg Engl. 2018 Jan;100(1):21-25. doi: 10.1308/rcsann.2017.0098. Epub 2017 Sep 15.
Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.
目的 本研究评估阴茎骨折患者一期尿道重建的结果。材料与方法 2005年1月至2016年4月期间，因阴茎骨折接受一期尿道重建的患者被要求进行随访。回顾性分析流行病学和临床表现数据以及手术所见。部分尿道损伤主要通过在尿道导管上间断缝合可吸收缝线进行治疗。对于完全性尿道损伤病例，进行无张力端端吻合术。术后第三个月起，所有患者均使用国际前列腺症状评分问卷和尿流率测定进行访谈。对有尿路症状或尿流率改变的患者进行逆行尿道膀胱造影，以排除或确认尿道狭窄。结果 175例阴茎骨折患者中，27例（15.4%）合并尿道损伤。所有患者均通过临床病史和体格检查诊断为阴茎骨折，未进行后续检查。年龄范围为30岁至58岁（平均39.2岁）。所有骨折均由性行为导致。报告的性行为姿势中，8例（61.5%）为“后入式”，5例（38.4%）为“男上女下式”。10例（76.9%）患者出现血尿，10例（76.9%）有尿道出血，4例（30.7%）发生尿潴留。分别在4例（30.7%）和9例（69.2%）患者中观察到海绵体单侧和双侧损伤；9例（69.3%）为部分损伤，4例（30.7%）为完全性尿道损伤。所有完全性尿道损伤病例均合并海绵体双侧损伤。6例最大尿流率低于15 ml/s和/或国际前列腺症状评分高于7分的患者接受了逆行尿道膀胱造影，所有病例结果均正常，排除了尿道狭窄的可能性。2例（15.3%）患者出现手术术后并发症，表现为尿道皮肤瘘和端端吻合区域附近的皮下脓肿。结论 阴茎骨折是一种罕见的泌尿外科急症，尤其是合并尿道损伤时。当临床表现提示或存在高能创伤时，尤其是海绵体双侧损伤时，必须怀疑此病。这些情况下无需补充影像学检查，不应延迟立即探查。一期尿道成形术效果满意，并发症发生率低。尽管如此，仍应进行更大样本量的前瞻性研究。
