針對外傷性尿道完全分離患者進行早期內視鏡重接手術-中國附醫的經驗
張天佑、黃志平
中國附醫泌尿科
Early endoscopic realignment for traumatic urethral total disruption- CMUH experience
Tian-You Chang, Chi-Ping Huang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Introduction:
to report our experience with 8 patients suffered from traumatic posterior urethra total disruption.
Materials and Methods:
The study includes 8 patients presented to our institute, between May 2008 and April 2019, with post-traumatic complete posterior urethral disruption. Preoperative retrograde urethrography, cystourethrography or abdominopelvic CT were performed to evaluate the urethral defect length, the bladder neck competence, the prostate position, and the extent of the pelvic hematoma, presence of pubic bone fracture and severity of dislocation. Early realignment was defined by placement of urethra foley within 14 days. Retrograde urethrography or urethroscopy were performed after the removal of the foley. Follow up UFM after foley removal.
Results:
8 patients in the age group 22-50 years were treated. 4(50%) was treated by endoscopic early realignment, 4 (50%)was treated by suprapubic cystostomy then receive urethroplasty. 1patient in each group loss follow up within 1year. 1 patient in early realignment group was found foley dislodge during f/u cystourethragrphy and receive endoscopic realignment 3month later. One patient in each group had achieved sounding free. Average Qmax was 11.6 and 5.4ml/s, not statistically significant difference.
Conclusions:
This study cannot make definite conclusion on whether early endoscopic realignment will be better than delay reconstruction. However, severe fibrosis was encountered in all patient of delay reconstruction group, making this procedure very difficult. Early endoscope realignment might be a safer and more feasible method for posterior urethra total disruption.