骨盆骨折尿道損傷的早期重建治療是否有較低尿道狹窄率的關連性?在亞洲台灣族群的研究
廖丞晞1,2,4、莫之欣6、吳汐淇2,5
1國軍台中總醫院外科部泌尿外科; 2中國醫藥大學臨床醫學及生物醫學研究所; 4國防醫學院臨床醫學研究所; 5中國醫藥大學附設醫院創傷及急診中心; 6中國醫藥大學附設醫院健康資料管理辦公室
Is Early Realignment of Urethra Injury in Pelvic Fracture Associated with Lower Urethra Stricture Rate? An Asian Population Study in Taiwan
Cheng-Hsi Liao1,2,4, Chih-Hsin Muo6, and Shi-Chi Wu2,5
1 Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, Taichung, Taiwan, R.O.C.; 2 Graduate Institute of Clinical Medical Science & Biomedical Sciences, China Medical University, Taichung, Taiwan, R.O.C.; 3 Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan, R.O.C; 4 Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C.;5 Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan, R.O.C.;6Management Office for Health Data, China Medical University and Hospital, R.O.C
Purpose: The management of pelvic fracture urethral injury (PUFI) remains challenging and controversial. Major controversies focused on the timing to realign the urethra. We try to evaluate the role of early urethra realignment in PUFI patients.
Materials and Methods: From National Health Insurance database of Taiwan, we collected hospitalized patients with PUFI between 1998 and 2010 and exclude history of urethral stricture or urethra reconstruction. Patients were classified into three groups: 1. Received cystoscopy and catheter realignment. 2. Repair of urethra within 30 days. 3. Repair of urethra after 30 days. The risk of urethral stricture and reconstruction and assessment of urethra reconstruction frequency among different groups were measured. The surgeon’s experiences was measured and based on the experiences for repairing urethra.
Results: A total 176 patients were included, there were 80 patients (45.5%) in group 1, 75 patients (42.6%) in group 2, 21 patients (11.9%) in group 3. Compared to group 1, the risk of urethral stricture were 2.40- and 2.37-fold in group 2 and 3. The risk of urethra reconstruction in group 2 was significant higher than group 1 (HR = 3.17). The frequency of urethra reconstruction was highest in group 3 (RR = 6.71), followed by group 2 (RR = 2.62). There were lower incidences of urethra stricture and reconstruction in group 2 and 3 if managed by experienced surgeon.
Conclusions: In PUFI patients, early primary realignment was associated with lesser urethra stricture rate and more cost effective. Moreover, experienced surgeons was with lesser complications. Further studies are warranted.