Wang J W, Man L B, Huang G L, Wang H, Xu X, Zhu X F, Li W, Liu Z H
Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing 100096, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Aug 18;50(4):617-620.
To evaluate the clinical effect of "3-step" strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients.
We retrospectively reviewed the clinical data of 162 male patients with simple traumatic posterior urethral stricture or stenosis admitted from January 2014 to October 2015. All had no complex complications, such as urethroperineal fistulas or urethrorectal fistulas. Before referral to Department of Urology, Beijing Jishuitan Hospital, 64 patients had undergone previous treatments: urethroplasty in 30 patients (18.5%), early urethral realignment in 17 patients (10.5%) and 17 patients (10.5%) who had undergone internal urethrotomy. The remaining 98 patients received the suprapubic cystostomy in the acute setting. All of them had received transperineal anastomotic urethroplasty with "3-step" strategy. Step 1, the bulbar urethra was circumferentially mobilized and tension-free anastomosis could be performed after the scar was completely incised and removed. Step 2, if after step 1 a tension-free anastomosis could not be achieved, were routed the distal urethra between the separated corporal bodies. Step 3, if the anastomosis still seemed to be under tension, we could perform pubectomy, partial or total removal, to get a better exposure of the apex of the prostate-membranous urethra.
The mean age of the patients included in this study was 36.3 years (rangingfrom 16-74 years). The mean time between incidents and operation was 13.5 months (ranging from 3-124 months) and the mean length of stricture was 2.7 cm (ranging from 0.5-6.5 cm).The mean time of operation was 92 (45-240) min and the mean evaluated blood lose was 120 (60-800) mL. Three patients (1.9%) received blood transfusing during or after the operations. The numbers of the patients who completed step 1, step 2 and step 3 were 50(30.9%), 74(45.7%) and 38(23.5%), respectively. There were 4 (2.5%) patients who needed the combined transpubic and transperineal approach for tension-free anastomosis after removing an entire wedge of anterior pubis. The mean follow-up was 19.5 months and 18 patients' strictures recurred with manifestation of decreased stream of dysuria. The overall success rate was 88.9%(144/162).
Based on the "3-step" strategy of transperineal anastomotic urethroplasty, patients with simple PFUDD can achieve a tension-free anastomosis. The present clinical data showed a successful rate of 88.9% (144/162).
评估经会阴吻合尿道成形术“三步”策略治疗男性单纯骨盆骨折尿道牵张缺损的临床效果。
回顾性分析2014年1月至2015年10月收治的162例男性单纯创伤性后尿道狭窄或闭锁患者的临床资料。所有患者均无尿道会阴瘘或尿道直肠瘘等复杂并发症。在转诊至北京积水潭医院泌尿外科之前，64例患者曾接受过治疗：30例患者（18.5%）接受过尿道成形术，17例患者（10.5%）接受过早期间断尿道会师术，17例患者（10.5%）接受过尿道内切开术。其余98例患者在急性期接受了耻骨上膀胱造瘘术。所有患者均接受了采用“三步”策略的经会阴吻合尿道成形术。第一步，环形游离球部尿道，完全切开并切除瘢痕后进行无张力吻合。第二步，如果第一步后无法实现无张力吻合，则将远端尿道经分离的阴茎海绵体之间引出。第三步，如果吻合仍有张力，可进行耻骨切除术，部分或全部切除，以更好地暴露前列腺膜部尿道顶端。
本研究纳入患者的平均年龄为36.3岁（16 - 74岁）。受伤至手术的平均时间为13.5个月（3 - 124个月），狭窄平均长度为2.7 cm（0.5 - 6.5 cm）。平均手术时间为92（45 - 240）分钟，平均估计失血量为120（60 - 800）mL。3例患者（1.9%）在手术期间或术后接受了输血。完成第一步、第二步和第三步的患者人数分别为50例（30.9%）、74例（45.7%）和38例（23.5%）。4例患者（2.5%）在切除整块耻骨前缘后需要联合经耻骨和经会阴入路以实现无张力吻合。平均随访19.5个月，18例患者狭窄复发，表现为排尿困难、尿流减少。总体成功率为88.9%（144/162）。
基于经会阴吻合尿道成形术的“三步”策略，单纯骨盆骨折尿道牵张缺损患者可实现无张力吻合。目前的临床资料显示成功率为88.9%（144/162）。
