Lv Rong, Jin Chongrui, Shu Huiquan, Wang Lin, Sa Yinglong
Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
BMC Urol. 2020 Nov 4;20(1):179. doi: 10.1186/s12894-020-00741-z.
Girls' pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap.
We retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients' trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior ureth roplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children.
Operation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period.
Our method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.
女童骨盆骨折导致膀胱颈撕脱和尿道断裂虽罕见，但发病率高。其治疗复杂且尚无标准方案。我们报告采用膀胱前壁瓣进行膀胱颈重建的经验及技术。
回顾性分析2017年7月至2019年10月我院收治的5例骨盆骨折致膀胱颈撕脱和尿道断裂女童的数据。她们均带着耻骨上造瘘管入院。患者创伤最初均在其他医院治疗，4例行耻骨上膀胱切开术，1例行尿道会师术。1名女童还在其他医院接受过3次尿道成形术。我们对这5名女童行耻骨切除术、后尿道成形术及膀胱前壁瓣膀胱颈重建术。术后评估包括拔除尿道导管后的排尿性膀胱尿道造影、尿流率测定和尿道镜检查。获得了患儿父母或法定监护人参与研究的口头同意。
手术时间为120至180分钟。随访时间为12至27个月。尿流率测定显示最大尿流率显著改善。排尿性膀胱尿道造影显示尿道连续性良好。2名女童术后出现尿失禁，但3个月后恢复控尿。1例患者发生膀胱腹壁瘘，6个月后手术修复，此后一直控尿。随访期间未观察到其他并发症。
我们使用膀胱瓣作为补片进行膀胱颈重建的方法可行，能实现良好控尿，尤其适用于因广泛创伤导致严重膀胱颈撕脱和尿道断裂以及创伤后尿道牵张需二次修复的患者。
