會陰部尿道造口用以處理複雜性尿道損傷之經驗-病例報告
黃靖崴、王大民
林口長庚紀念醫院外科部泌尿外科
Perineal urethrostomy for compliicated urethral stricture
Ching-wei Huang, Ta-min Wang
Department of Surgery, Division of Urology, Chang Gung Memorial Hospital at Linkou
Purpose:
To propose two cases of complicated urethral stricture cases and its subsequent management with perineal urethrotomy and outcome
Materials and Methods:
Case 1: A-60-year-old male patient with complicated penile trauma with total separation of penile cavernosum 20 years ago. Post debridement but urine leakage from the base of penis noted ever since. Due to total loss of penile urethra, perineal urethrotomy was done on 2015/12/2. Foley was removed 8 days later. Adequate urine flow noted after completion of treatment with cystolithotripsy. Stable condition and free of catheter during out-patient clinic follow up.
Case 2: A 71-year-old male patient suffered from difficulty in voiding for months post optic urethrotomy twice in local hospital. The patient was then transferred for complicated urethral stricture over meatus. Cystostomy was done first and cystoscopy evaluation failed due to multiple stricture site. Operation was arranged on 2016/11/07 and catheter was removed ten days later. Adequate self-voiding achieved with mild urinary tract infection under antibiotics control now.
Results:
Both cases managed with perineal urethrotomy showed marked improvement in quality of life. Before the operation, they both suffered from severe obstructive symptoms such as staining, acute urine retention and even repeated urinary tract infection symptoms. During post-OP follow up, both cases are now catheter-free with adequate continence. One case now still suffered from intermittent urinary tract infection but much improved when comparing with pre-OP condition.
Conclusion:
Perineal urethrotomy is an effective treatment method when repair of urethra is not feasible during complicated urethral injury or urethral loss. No impact on continence and significant improvement in QoL in our two patients. Perineal urethrotomy should be considered as last chance for this kind of patients.