Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Int J Urol. 2019 Jun;26(6):596-607. doi: 10.1111/iju.13947. Epub 2019 Mar 20.
Pelvic fractures from high-energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.
骨盆骨折由高能量钝性暴力引起，可能导致后尿道损伤，即骨盆骨折尿道损伤，其最常与不稳定骨盆骨折相关。如果骨盆创伤患者尿道口有血和/或排尿困难，应怀疑骨盆骨折尿道损伤，如果患者稳定，应进行逆行尿道造影。一旦确认尿道损伤，应立即通过耻骨上管引流或通过尿道导管进行尿道直接吻合术来建立尿流。尽管骨盆骨折尿道损伤后会伴有较高的尿道狭窄发生率，并且已经认为直接吻合术可以降低尿道狭窄的风险，但它也有导致狭窄的风险，其临床意义仍存在争议。一旦炎症和纤维化稳定（一般在创伤后至少 3 个月），尿道狭窄的最佳处理方法是延迟尿道成形术。延迟尿道成形术可通过会阴入路，分步骤使用 4 种辅助技术（球部尿道松解、阴茎海绵体分离、耻骨下切除和尿道改道）进行。尽管骨盆创伤可能会损害控尿机制，但据报道，骨盆骨折尿道损伤修复后的控尿效果是足够的。由于骨盆骨折尿道损伤后常发生勃起功能障碍，且大多数患者年轻，预期寿命长，因此其适当的处理可以极大地提高生活质量。本文回顾了骨盆骨折尿道损伤处理的关键因素，并总结了当前的热点问题。
