Elliott D S, Barrett D M
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 1997 Mar;157(3):814-6.
We analyzed the long-term results of treatment of posterior urethral disruptions with immediate primary realignment.
A total of 57 patients with posterior urethral disruptions (56 complete and 1 partial) underwent primary urethral realignment within 6 hours after injury. Pelvic fractures were present in 52 patients. In all cases the actual operating time for realignment was 1.25 hours or less. All patients were evaluated postoperatively for incontinence, impotence and strictures. Mean followup was 10.5 years (range up to 40 years) after injury and 53 patients were available for long-term followup.
Erections-42 of 53 patients (79%) reported no erectile dysfunction, 7 (13%) reported decreased quality of erection but required no treatment and 4 (7.5%) had erectile dysfunction requiring treatment. Incontinence-2 of 53 patients (3.7%) reported mild post-realignment stress incontinence. Both patients did not need treatment for incontinence or protective padding. Strictures-18 of 53 patients (34%) had evidence of post-realignment strictures and required no further urethral dilation or surgical intervention. Mean followup for these 18 patients was 12 years 2 months. A total of 36 patients (68%) had post-realignment strictures; however, 23 (43.4%) were considered to have mild strictures that were observed or easily managed with in-office dilation. Mean followup for these patients was 8.5 years. Of the 53 patients 13 (24.5%) had more significant strictures that required a repeat procedure using general anesthesia. A total of 20 procedures was required to treat the 13 patients. Of the 20 procedures done using general anesthesia 16 (80%) were completed on an outpatient basis. The remaining 4 patients required urethroplasty. Mean followup of the 13 patients was 11 years 9 months.
Immediate primary realignment resulted in negligible intraoperative morbidity, and acceptably low incidences of impotence, incontinence and symptomatic strictures.
我们分析了即刻一期尿道会师治疗后尿道断裂的长期结果。
共有57例后尿道断裂患者（56例完全断裂和1例部分断裂）在受伤后6小时内接受了一期尿道会师。52例患者合并骨盆骨折。所有病例中，实际会师手术时间为1.25小时或更短。所有患者术后均接受了尿失禁、阳痿和尿道狭窄方面的评估。受伤后平均随访时间为10.5年（范围长达40年），53例患者可进行长期随访。
勃起功能——53例患者中有42例（79%）报告无勃起功能障碍，7例（13%）报告勃起质量下降但无需治疗，4例（7.5%）有勃起功能障碍需要治疗。尿失禁——53例患者中有2例（3.7%）报告会师后有轻度压力性尿失禁。这2例患者均无需尿失禁治疗或使用护垫。尿道狭窄——53例患者中有18例（34%）有会师后尿道狭窄的证据，无需进一步尿道扩张或手术干预。这18例患者的平均随访时间为12年2个月。共有36例患者（68%）有会师后尿道狭窄；然而，23例（43.4%）被认为有轻度狭窄，通过观察或门诊扩张即可轻松处理。这些患者的平均随访时间为8.5年。53例患者中有13例（24.5%）有更严重的狭窄，需要再次进行全身麻醉手术。治疗这13例患者共需要20次手术。在20次全身麻醉手术中，16例（80%）在门诊完成。其余4例患者需要进行尿道成形术。这13例患者的平均随访时间为11年9个月。
即刻一期尿道会师导致术中并发症可忽略不计，阳痿、尿失禁和有症状尿道狭窄的发生率低至可接受程度。
