尿道損傷治療的時機—多重創傷患者的臨床困境
陳昱廷1、王大民1、傅志遠2
1林口長庚紀念醫院外科部泌尿科，2林口長庚紀念醫院外科部外傷急症外科
Timing of Urethral Injury Treatment – A Clinical Dilemma in Patients with Poly Trauma
Yu‑Ting Chen1, Ta-Min Wang1, Chih-Yuan Fu2
1Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
2Division of Trauma and Emergency Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Purpose:
The ideal timing of urethral injury treatment remains controversial. Early endoscopic intervention may reduce the chance of future open urethral reconstruction, decrease the risk of urethral stricture, and prevent complications associated with the initial suprapubic cystostomy; while delayed urethroplasty carries a very high risk of urethral stricture and frequently necessitates repeated reconstructive procedures. In the current study, outcomes between urethral injury patients who underwent an early or a delayed treatment were compared. The timing of treatment for patients among different situations were analyzed.
Materials and Methods:
Urethral injury patients from 2011 to 2020 in our institution were retrospectively reviewed. The information including gender, age, injury severity score (ISS), abbreviated injury scale of abdomen (AIS-abdomen), mechanism of injury, location and severity of urethral injury, presence of pelvic fracture or not, patterns of surgical interventions, timing of surgeries, and urethral-related complications were collected. Early intervention and delayed intervention (more than one month after the injury) patients were compared. Factors of three urinary complications (urethral stricture, erectile dysfunction, and urinary incontinence) were analyzed using multivariate logistic regression models respectively. A subset analysis for patients with minor injuries (ISS<16) was performed to evaluate the effect of delayed surgery in these patients who could undergo an early treatment of urethral injuries.
Results:
There were 72 male urethral injury between 2011 to 2020, and 4 were excluded due to major trauma with death within a few days. In total, patients who underwent delayed treatment (N=30) had a significantly higher stricture rate (p = 0.025) and erectile dysfunction (ED) rate (p < 0.001) and a significantly higher ISS (p = 0.048) than early treatment patients (N=38). Multivariate analyses of urinary tract complications showed that urethral injury type was significantly associated with urethral stricture (p = 0.036); delayed treatment was significantly associated with the ED (p = 0.023); while age (p = 0.010) and the presence of angioembolization for hemostasis (p = 0.046) were significantly associated with the incontinence. In patients with ISS less than 16, more ED were observed in patients who underwent the delayed treatment (p = 0.048).
Conclusion:
The treatment of urethral injury may be delayed because of multiple trauma and other associated injuries. However, more complications were observed in patients who underwent the delayed urethral injury treatment. The early treatment of urethral injury was suggested if possible.