Barratt Rachel C, Bernard Jason, Mundy Anthony R, Greenwell Tamsin J
Department of Urology, University College London Hospital, London, UK.
Department of Orthopaedic and Trauma Surgery, St. George's University Hospital, London, UK.
Transl Androl Urol. 2018 Mar;7(Suppl 1):S29-S62. doi: 10.21037/tau.2017.12.35.
Pelvic fracture urethral injury (PFUI) management in male adults and children is controversial. The jury is still out on the best way to manage these injuries in the short and long-term to minimise complications and optimise outcomes. There is also little in the urological literature about pelvic fractures themselves, their causes, grading systems, associated injuries and the mechanism of PFUI. A review of pelvic fracture and male PFUI literature since 1757 was performed to determine pelvic fracture classification, associated injuries and, PFUI classification and management. The outcomes of; suprapubic catheter (SPC) insertion alone, primary open surgical repair (POSR), delayed primary open surgical repair (DPOSR), primary open realignment (POR), primary endoscopic realignment (PER), delayed endoscopic treatment (DET) and delayed urethroplasty (DU) in male adults and children in all major series have been reviewed and collated for rates of restricture (RS), erectile dysfunction (ED) and urinary incontinence (UI). For SPC, POSR, DPOSR, POR, PER, DET and DU; (I) mean RS rate was 97.9%, 53.9%, 18%, 58.3%, 62.0%, 80.2%, 14.4%; (II) mean ED rate was 25.6%, 22.5%, 71%, 37.2%, 23.6%, 31.9%, 12.7%; (III) mean UI rate was 6.7%, 13.6%, 0%, 14.5%, 4.1%, 4.1%, 6.8%; (IV) mean FU in months was 46.3, 29.4, 12, 61, 31.4, 31.8, 54.9. For males with PFUI restricture and new onset ED is lowest following DU whilst UI is lowest following DPOSR. On balance DU offers the best overall outcomes and should be the treatment of choice for PFUI.
成年男性和儿童骨盆骨折所致尿道损伤（PFUI）的治疗存在争议。对于如何在短期和长期内以最佳方式处理这些损伤，以尽量减少并发症并优化治疗效果，尚无定论。泌尿外科文献中关于骨盆骨折本身、其病因、分级系统、相关损伤以及PFUI的机制也很少。对自1757年以来的骨盆骨折和男性PFUI文献进行了综述，以确定骨盆骨折分类、相关损伤以及PFUI的分类和治疗方法。回顾并整理了所有主要系列中成年男性和儿童单纯耻骨上导管插入术（SPC）、一期开放手术修复（POSR）、延迟一期开放手术修复（DPOSR）、一期开放复位（POR）、一期内镜复位（PER）、延迟内镜治疗（DET）和延迟尿道成形术（DU）的治疗结果，包括狭窄（RS）、勃起功能障碍（ED）和尿失禁（UI）的发生率。对于SPC、POSR、DPOSR、POR、PER、DET和DU；（I）平均RS发生率分别为97.9%、53.9%、18%、58.3%、62.0%、80.2%、14.4%；（II）平均ED发生率分别为25.6%、22.5%、71%、37.2%、23.6%、31.9%、12.7%；（III）平均UI发生率分别为6.7%、13.6%、0%、14.5%、4.1%、4.1%、6.8%；（IV）平均随访月数分别为46.3、29.4、12、61、31.4、31.8、54.9。对于患有PFUI狭窄的男性，新发ED在DU后最低，而UI在DPOSR后最低。总体而言，DU提供了最佳的整体治疗效果，应成为PFUI的首选治疗方法。
