Yamada Masumi, Horiguchi Akio, Kawamura Kazuki, Ojima Kenichiro, Shinchi Masayuki, Ito Keiichi, Asano Tomohiko, Azuma Ryuichi
Department of Urology, National Defense Medical College.
Division of Plastic Surgery, National Defense Medical College.
Nihon Hinyokika Gakkai Zasshi. 2018;109(3):173-177. doi: 10.5980/jpnjurol.109.173.
Pelvic fracture urethral injury (PFUI) is relatively rare injury, and delayed urethroplasty is the gold standard for its repair. Because a failed urethroplasty results in increased scarring and reduced length of the available urethral segment, the salvage urethroplasty is a urologic challenge. We herein report the case of male patient with PFUI who could be salvaged after three failed urethroplasties. A 22-year-old male who had received a PFUI when he was 4 years old was referred for salvage urethroplasty after two perineal anastomotic urethroplasties and one transpubic urethroplasty had failed, leaving him unable to void and forced to keep having a suprapubic tube placed. The meatus was iatrogenically obliterated due to repeated treatments. Through an incision from the scrotum and right side of the root of the penis to the lower abdomen, the anterior urethra was circumferentially mobilized and transected at the distal urethral stump. The proximal urethral end was identified by palpitation with a metallic sound inserted through the suprapubic tube tract. The covering fibrotic scar tissue was completely removed and 8 anastomotic 4-0 polydioxanone sutures were placed to reapproximate the urethral mucosa. A pedicled gracilis muscle flap was created and wrapped around the anastomosis site and intrapelvic segment of the mobilized anterior urethra. A urethrogram 8 months after urethroplasty showed a wide caliber at the anastomosis site and a ventral midline meatotomy was subsequently performed. He is currently free from any instruments and can void well without the need for further intervention.
骨盆骨折所致尿道损伤（PFUI）相对少见，延迟尿道成形术是其修复的金标准。由于尿道成形术失败会导致瘢痕增加和可用尿道段长度缩短，挽救性尿道成形术是一项泌尿外科挑战。我们在此报告一例PFUI男性患者，在三次尿道成形术失败后成功挽救的病例。一名22岁男性，4岁时发生PFUI，在两次会阴吻合尿道成形术和一次经耻骨尿道成形术失败后，因无法排尿且被迫持续留置耻骨上造瘘管而前来接受挽救性尿道成形术。由于反复治疗，尿道口被医源性闭塞。通过从阴囊和阴茎根部右侧至下腹部的切口，将前尿道环形游离并在尿道远端残端切断。通过经耻骨上造瘘管通道插入金属探子触诊确定近端尿道端。彻底切除覆盖的纤维化瘢痕组织，放置8根吻合用4-0聚二氧六环酮缝线使尿道黏膜重新对合。制作带蒂股薄肌瓣并包裹吻合部位及游离的前尿道盆腔段。尿道成形术后8个月的尿道造影显示吻合部位管径宽大，随后进行了腹侧中线尿道口切开术。他目前无需任何器械辅助，排尿良好，无需进一步干预。
