Schönberg Gita M, Nyarangi-Dix Joanne, Radtke Jan-Philip, Hohenfellner Markus, Santucci Richard
Department of Urology, University Hospital, University of Heidelberg, Heidelberg, Germany, and Department of Urology, Detroit Medical Center (RS), Detroit, Michigan.
Urol Pract. 2014 Jul;1(2):92-99. doi: 10.1016/j.urpr.2014.03.001. Epub 2014 Apr 24.
We provide an overview of the terminology, anatomical considerations, pathophysiology, diagnostic evaluation and contemporary management strategies of male urethral emergencies.
We reviewed the literature, including the latest EAU (European Association of Urology) guidelines.
Iatrogenic injuries are the most common cause of urethral injuries. Traumatic injuries are contusion, stretch or partial or complete injury of the anterior and/or posterior urethra. Blunt injuries are most frequently treated initially with suprapubic urinary drainage and, if necessary, subsequent urethroplasty. Early realignment is controversial and can be attempted in stable patients. Except in rare cases most pelvic fracture urethral injuries are treated with delayed anastomotic urethroplasty. For other injuries such as contusions, depending on the length and localization of the fibrotic gap end-to-end anastomosis or augmented urethroplasty is performed. Penetrating or open injuries are variably managed by initial urinary diversion or wound débridement, hematoma evacuation and, if possible, primary urethral anastomosis.
Primary repair of fractured penis is recommended and immediate primary repair is especially important for suspected associated urethral injury.
我们概述了男性尿道急症的术语、解剖学考量、病理生理学、诊断评估及当代治疗策略。
我们回顾了相关文献，包括最新的欧洲泌尿外科学会（EAU）指南。
医源性损伤是尿道损伤最常见的原因。创伤性损伤包括前尿道和/或后尿道的挫伤、拉伸或部分或完全损伤。钝性损伤最初最常采用耻骨上膀胱造瘘引流治疗，必要时随后进行尿道成形术。早期复位存在争议，可在病情稳定的患者中尝试。除极少数情况外，大多数骨盆骨折所致尿道损伤采用延迟吻合性尿道成形术治疗。对于其他损伤如挫伤，根据纤维化间隙的长度和部位进行端端吻合或扩大尿道成形术。穿透性或开放性损伤的处理方式多样，初期可行尿液改道或伤口清创、血肿清除，如有可能则进行一期尿道吻合。
建议对阴茎骨折进行一期修复，对于疑似合并尿道损伤的情况，立即进行一期修复尤为重要。
