Wang Zeyu, Song Guoping, Xiao Yunfeng, Liang Tao, Wang Feixiang, Gu Yubo, Zhang Jiong, Xu Yuemin, Jin Sanbao, Fu Qiang, Song Lujie
Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.
Transl Androl Urol. 2020 Dec;9(6):2596-2605. doi: 10.21037/tau-20-1064.
To investigate the correlation between the magnetic resonance urethrography and the surgical approach and complexity for the patients with pelvic fracture urethral injury (PFUI) by combining the geometry with magnetic resonance imaging (MRI).
Forty-three male patients with PFUI (part of the patients complicated with rectal injury) from January 2016 to December 2018 were analyzed in this retrospective research. All the patients underwent a delayed anastomotic urethroplasty and were divided into 2 groups according to the approaches (simple perineal approach or inferior pubectomy). For magnetic resonance urethrography, we measured and calculated the geometric parameters such as the gap distance between two urethral ends, the pubourethral vertical distance (PUVD), and the rectourethral median distance (RUMD).
Of the 43 patients, 16 underwent inferior pubectomy and 27 underwent simple perineal approach. The numbers of patients with and without rectal injury history were 17 and 26, respectively. The operation time and intraoperative blood loss was significantly higher in the inferior pubectomy group. Multivariate logistic analysis revealed that gap distance and PUVD were independent factors of the surgical approaches. The accuracies were 83.7% and 67.4% respectively in the ROC curve analysis. In addition, the RUMD was significantly shorter in the patients with rectal injury history (1.4, 1.8 cm).
Longer gap distance and shorter PUVD were the two independent factors of the inferior pubectomy approach. Furthermore, among the patients with rectal injury history, the tissue posterior to the urethra was often weaker and should be carefully handled during the surgery.
This research has been registered on the Chinese Clinical Trial Registry. The registration number is ChiCTR2000030573.
通过将几何学与磁共振成像（MRI）相结合，研究骨盆骨折尿道损伤（PFUI）患者的磁共振尿道造影与手术方式及复杂性之间的相关性。
本回顾性研究分析了2016年1月至2018年12月期间43例男性PFUI患者（部分患者合并直肠损伤）。所有患者均接受了延迟吻合尿道成形术，并根据手术方式（单纯会阴入路或耻骨下切除术）分为两组。对于磁共振尿道造影，我们测量并计算了几何参数，如尿道两端的间隙距离、耻骨尿道垂直距离（PUVD）和直肠尿道中位距离（RUMD）。
43例患者中，16例行耻骨下切除术，27例行单纯会阴入路。有直肠损伤史和无直肠损伤史的患者人数分别为17例和26例。耻骨下切除术组的手术时间和术中出血量明显更高。多因素logistic分析显示，间隙距离和PUVD是手术方式的独立因素。ROC曲线分析中的准确率分别为83.7%和67.4%。此外，有直肠损伤史的患者RUMD明显更短（1.4、1.8 cm）。
间隙距离较长和PUVD较短是耻骨下切除术入路的两个独立因素。此外，在有直肠损伤史的患者中，尿道后方的组织往往较弱，手术中应谨慎处理。
本研究已在中国临床试验注册中心注册。注册号为ChiCTR2000030573。
