Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.
World J Urol. 2021 Dec;39(12):4435-4441. doi: 10.1007/s00345-021-03789-0. Epub 2021 Jul 10.
The aim was to reduce the difficulty of transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) and make it easy to master through an effective strategy.
Between January 2010 and December 2019, 1637 patients with PFUDDs were treated by transperineal anastomotic urethroplasty. The surgical strategy we used was the progressive transperineal anastomotic urethroplasty. First, after full mobilization of the distal bulbomembranous urethra, the stenotic urethra was transected directly at the proximal margin of the stenotic urethra to expose the proximal disrupted urethral end. Second, if the urethral stenosis location of some complicated cases was too deep to fully mobilize, the position of urethral transection was selected at the distal margin of the stenotic urethra. Then, the distal and proximal disrupted urethras were then trimmed and anastomosed without tension. A successful urethroplasty was defined as reestablishment of a uniform urethral caliber and no further interventions were needed.
Follow-up was obtained in 1475 patients. The success rate was 92.4% (1363/1475). Among the 112 failed patients, 10 patients received endoscopic urethrotomy, 99 underwent a secondary or third anastomotic urethroplasty and 3 successfully treated with perineal skin flap urethroplasty. After final successful urethroplasty, 125 patients (8.5%) had different degrees of urinary incontinence and 15 (1.6%) developed de novo erectile dysfunction (1.6%).
The progressive transperineal anastomotic urethroplasty strategy was effective for treating PFUDD cases, improving surgical efficacy and reducing complications. It may contribute to standardizing the transperineal anastomotic urethroplasty and making it easy to master.
旨在通过有效的策略降低经会阴吻合尿道成形术治疗骨盆骨折后尿道会师缺损（PFUDD）的难度，使其易于掌握。
2010 年 1 月至 2019 年 12 月，1637 例 PFUDD 患者接受经会阴吻合尿道成形术治疗。我们采用的手术策略是逐步经会阴吻合尿道成形术。首先，在充分游离球海绵体肌尿道的远端后，直接在狭窄尿道的近端边缘切开狭窄尿道，暴露近端断裂的尿道末端。其次，如果一些复杂病例的尿道狭窄位置太深而无法充分游离，则选择在狭窄尿道的远端边缘进行尿道切开。然后，无张力修剪并吻合远端和近端断裂的尿道。尿道成形术成功定义为重建均匀的尿道口径，无需进一步干预。
1475 例患者获得随访。成功率为 92.4%（1363/1475）。在 112 例失败的患者中，10 例接受了内镜尿道切开术，99 例接受了二次或三次吻合尿道成形术，3 例成功接受了会阴皮瓣尿道成形术。最终成功尿道成形术后，125 例（8.5%）患者出现不同程度的尿失禁，15 例（1.6%）新发勃起功能障碍（1.6%）。
逐步经会阴吻合尿道成形术策略治疗 PFUDD 效果良好，可提高手术疗效，减少并发症。这可能有助于规范经会阴吻合尿道成形术并使其易于掌握。
