Oosterlinck W
Department of Urology, University Hospital Ghent, Belgium.
Acta Urol Belg. 1998 May;66(2):49-53.
Whenever trauma of the urethra is suspected a "test" catheterisation is potentially bad and useless. Retrograde urethrography should be performed before use of any catheter. Doctors in urgency department should be trained to do this. Suprapubic diversion under imaging guidance is the best solution when trauma is diagnosed. In complete rupture without extreme displacement of both ends of the urethra, reconstruction is foreseen at day 7 to 10 after trauma. Bleeding is stopped at that moment and elasticity of the tissues is still sufficient. A second urethrogram the day before intervention is advocated for better judgement of the lesions. Endoscopy with a flexible endoscope from above is performed as the first step of the operation. Minor distances or incomplete lesions of the urethra can be coped with endoscopic realignment. Distances of more than 1 cm are treated by open perineal route only leaving the pelvic hematoma closed. This technique should be restricted to referee centers in view of the small numbers of cases.
每当怀疑有尿道创伤时，进行“试探性”导尿可能是有害且无用的。在使用任何导尿管之前，都应进行逆行尿道造影。急诊科医生应接受相关培训。当诊断出创伤时，在影像引导下进行耻骨上膀胱造瘘是最佳解决方案。在尿道两端无极度移位的完全断裂情况下，预计在创伤后7至10天进行重建。此时出血已停止，组织弹性仍足够。主张在干预前一天进行第二次尿道造影，以更好地判断损伤情况。手术的第一步是使用可弯曲的上尿路内窥镜进行内镜检查。尿道的小距离或不完全损伤可通过内镜下复位处理。超过1厘米的距离仅通过开放会阴途径治疗，保留盆腔血肿。鉴于病例数量较少，这项技术应限于参考中心。
