Transperineal surgery for pelvic fracture-induced posterior urethral atresia:Selection and application of surgical modality
10.13263/j.cnki.nja.2024.08.009
- VernacularTitle:骨盆骨折致后尿道闭锁的术式选择及应用
- Author:
Yu-Kui NAN
1
;
Lan-Ge GUO
;
Li-Zhong YAO
;
Hong-Liang JIA
;
Jiu-Zhi LI
Author Information
1. 新疆维吾尔自治区人民医院泌尿中心,新疆乌鲁木齐 830001
- Keywords:
pelvic fracture;
posterior urethral atresia;
end-to-end urethral anastomosis;
urethral pull-through operation
- From:
National Journal of Andrology
2024;30(8):730-733
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the selection of the modality of transperineal surgery and its effect in the treatment of pel-vic fracture-induced posterior urethral atresia(PUA).Methods:This study included 116 cases of PUA caused by pelvic fractures treated in our hospital from January 2012 to December 2021.We used transperineal resection of the urethral stricture and end-to-end u-rethral anastomosis(EEUA)as the first choice in the treatment of 79 cases.For the patients with the urethral atresia segment longer than 3 cm and evident urethral involution tension,we incised the penile septum,separated and removed the muscle tendon and scar tis-sue attached to the lower border of the pubis,and anastomosed with 4-0 absorbable thread for 8 stitches.For the other 37 cases for which we were not sure of effective suture of the membrane due to obvious scarring of the proximal urethra,the remaining urethra shor-ter than 5 mm or incomplete urethral mucosa,we selected conventional urethral pull-through operation(UPTO).We followed up the patients for 3-24 months postoperatively.Results:The total success rate of surgery was 78.4％(91/116),81.1％(30/37)in the UPTO and 77.2％(61/79)in the EEUA group,significantly higher in the former than in the latter(P=0.05).The rate of post-operative dysuria was remarkably lower in the UPTO than in the EEUA group(13.5％[5/37]vs 16.5％[13/79],P=0.05),and so was that of surgical failure(5.4％[2/37]vs 6.3％[5/79],P=0.05).The main causes of postoperative dysuria in the EEUA group included restenosis resulting from incomplete scar resection and the two sides of the anastomosed urethral segment not being at the coaxial level,while those in the UPTO group included the formation of mucosal flaps in the pulled-through urethra,and re-scarring leading to stricture or the pulled-through urethra not being at the coaxial level.Among the 7 cases of surgical failure due to recurrence,1 refused reoperation and opted for cystostomy tube drainage,and the other 6 underwent EEUA again 6 months later.Conclusion:EEUA is preferred as the first-choice surgery for PUA,while UPTO remains an effective treatment option in hospitals with preliminary skills and less experience in the management of PUA.
