Department of Urology, University of Washington, Seattle, WA, United States; Service d'urologie, hospices civils de Lyon, Lyon, France.
Department of Urology and Harborview Injury Prevention Center, University of Washington, Seattle, WA, United States.
Fr J Urol. 2024 Nov;34(10):102711. doi: 10.1016/j.fjurol.2024.102711. Epub 2024 Jul 27.
Pelvic fracture (PF) is a rare emergency, which led to pelvic fracture urethral injury (PFUI) in 1.6% to 25% of cases. Urethral injury assessment requires a thorough analysis of the initial injury history and imaging that combine cystourethrography acutely, repeat urethral imaging as well as adjunctive use of MRI in the follow-up period. A more complex surgical approach to the delayed reconstruction of PFUI may be predicted by the urethral gap length (cysto-urethrography) or a lower pubo-urethral angle (MRI). Delayed urethroplasty is the treatment of choice, performed once the patient has recovered from other acute injuries, typically at least 3months post-injury. It consists in men in a bulbo-prostatic anastomotic urethroplasty which may require several steps of increasing complexity to allow a tension-free anastomosis: corpora splitting, partial inferior pubectomy, and rarely total pubectomy or urethra rerouting. More complex cases of PFUI repair may be encountered (long gap between the two urethral segments, bulbar necrosis, false passage after failed endoscopic realignment, orthopedic hardware in pubic symphyseal region, pediatric PFUI, failed previous urethroplasty, associated anterior urethral stricture, or recto-urethral fistula) and should be managed in expert centers. Urethral patency is achieved by surgical reconstruction with an overall success rate of 86%. Evaluation of potential associated sequelae including erectile dysfunction and urinary incontinence must be anticipated and taken into consideration in the path of rehabilitation.
骨盆骨折（PF）是一种罕见的急症，其中 1.6%至25%的病例会导致骨盆骨折尿道损伤（PFUI）。尿道损伤评估需要对初始损伤病史和影像学进行彻底分析，包括急性膀胱尿道造影、重复尿道成像以及在随访期间辅助使用 MRI。如果尿道间隙长度（膀胱尿道造影）或耻骨尿道角较低（MRI），则可能需要更复杂的手术方法来延迟重建 PFUI。延迟性尿道成形术是首选治疗方法，应在患者从其他急性损伤中恢复后进行，通常至少在损伤后 3 个月进行。对于男性，可采用球部前列腺吻合术进行尿道成形术，该手术可能需要几个步骤来增加复杂性，以实现无张力吻合： corpora splitting、部分耻骨下切除术，极少数情况下需要耻骨全切除术或尿道改道术。更复杂的 PFUI 修复病例（两段尿道之间间隙较长、球部坏死、内镜再吻合失败后出现假道、耻骨联合区骨科内固定、小儿 PFUI、先前尿道成形术失败、合并前尿道狭窄或直肠尿道瘘）可能需要在专家中心进行治疗。通过手术重建尿道来实现尿道通畅，总成功率为 86%。必须评估潜在的相关后遗症，包括勃起功能障碍和尿失禁，并在康复过程中加以考虑。
