Ríos Emilio, Martínez-Piñeiro Luís
Department of Urology, Universitary Hospital Infanta Sofia, Madrid, Spain.
Department of Urology, Universitary Hospital La Paz, Madrid, Spain.
Asian J Urol. 2018 Jul;5(3):164-171. doi: 10.1016/j.ajur.2017.12.004. Epub 2017 Dec 27.
Posterior urethral injuries typically arise in the context of a pelvic fracture. Retrograde urethrography is the preferred diagnostic test in trauma patients with pelvic fracture where a posterior urethral rupture is suspected. Pelvic fractures however preclude the adequate positioning of the patient on the X-ray table on admission and computed tomography scan with intravenous contrast and delayed films generally performed first. Suprapubic bladder catheter placement under ultrasound guidance should be performed whenever a posterior urethral disruption is suspected. Early diagnosis and proper acute management decrease the associated complications, such as strictures, urinary incontinence and erectile dysfunction. The correct and appropriate initial treatment of associated urethral rupture is critical to the proper healing of the injury. Placing of a suprapubic cystostomy on admission and delayed anastomotic urethroplasty after 3-6 months continues to be the gold standard of treatment. In this paper, we provide a comprehensive review of the literature with a special emphasis on the various treatments available: Open or endoscopic primary realignment, immediate or delayed urethroplasty after suprapubic cystostomy, and delayed optical urethrotomy.
后尿道损伤通常发生在骨盆骨折的情况下。逆行尿道造影是怀疑有后尿道破裂的骨盆骨折创伤患者首选的诊断检查。然而，骨盆骨折使患者入院时无法在X线检查台上进行充分的体位摆放，通常首先进行静脉造影增强计算机断层扫描及延迟片检查。只要怀疑有后尿道断裂，就应在超声引导下进行耻骨上膀胱造瘘管置入。早期诊断和适当的急性处理可减少相关并发症，如尿道狭窄、尿失禁和勃起功能障碍。相关尿道破裂的正确恰当的初始治疗对损伤的正确愈合至关重要。入院时行耻骨上膀胱造瘘术，3至6个月后行延迟性吻合尿道成形术仍是治疗的金标准。在本文中，我们对文献进行了全面综述，特别强调了现有的各种治疗方法：开放或内镜下一期复位、耻骨上膀胱造瘘术后即刻或延迟尿道成形术以及延迟性直视尿道切开术。
