Transperineal Urethroplasty for Treatment of Traumatic Severe Stricture of the Urethra：Experience and Literature Review

嚴重創傷性尿道狹窄經會陰行尿道重建術後：經驗及文獻回顧

李俊德(Chun-Te Lee) ； 李祥生(Shang-Sen Lee) ； 莊豐賓(Feng-Pin Chuang) ； 孫光煥(Guang-Huan Sun) ； 閻中原(Chung-Yang Yen) ； 馬正平(Cheng-Ping Ma) ； 張聖原(Sun-Yran Chang) ； 陳宏一(Hong-I Chen) ； 于大雄(Dah-Shyong Yu)

《中華民國泌尿科醫學會雜誌》 12卷2期 (2001/06) Pp. 85-90

https://doi.org/10.7024/JUAROC.200106.0085

摘要

研究目的: 經會陰尿道重建術是骨盆骨折合併後尿道斷裂，尤其針對長段尿道缺陷患者或為泌尿科醫生極富挑戰性之治療選擇，我們發表處理的經驗以及長期追蹤結果。
材料與方法: 從1993年至1999年間，共計8位因骨盆骨折合併嚴重後尿道損傷的病人於本院接受治療，所有病人皆先接受恥骨上膀胱造廔手術而後施行經會陰尿道重建行。臨床病史包括受傷機轉，相關的併發症以及經再次手歷程均予以記錄;術後復發（再狹窄）與否由膀胱鏡或逆行性尿道攝影得知，長期的排尿功能能電病人解尿後的餘尿量以及尿流速做評估。性功能則經由病人問卷得知。
結果:病患年齡平均為29.4歲（23~50），從恥骨上造廔術至經會陰尿道重建行之間隔時間平均為5.6個月（4~9個月），平均尿道狹窄長度為2.8公分（1.5~7公分），追蹤時間平均為48.5個月（17~73個月）。所有病人術後發生再狹窄比率為75%（6/8），合計接受了15次內視鏡尿道切開術以及20次尿道擴張術。所有8位病人目前尿道通暢，其中除1位合併神經性膀胱，餘7位病人排尿正常且可自制。有4位病人因骨盆骨折發生勃起功能障礙，佔50%（4/8），其中3位病人術後也復發尿道狹窄。
結論:由我們的經驗，術後的主要問題是再狹窄，然而可經由再次手術，如經內視鏡尿道切開術或尿道擴張術解決。至於病患勃起功能障礙方面，術前或術後並無差異。勃起功能障礙可能決定於後尿道受傷的同時並且可能為不可回復的傷害。再者，合併勃起功能障礙的病人可能較常發生於較嚴重的後尿道損傷患者，再狹窄機會也是如此。我們建議，所有患者術後應長期追蹤排尿以及性功能方面的評估檢查。

關鍵字

尿道受傷 ； 狹窄 ； 尿道重建術

並列摘要

OBJECTIVE: Transperineal urethroplasty is the treatment of choice for pelvic fractures with posterior urethral distractions, especially in cases of long-segment defect of the urethra or cases which are challenging to urologists. We present our experiences and long-term follow-up results.
MATERIALS AND METHODS: From 1993 through 1999, eight patients with severe posterior urethral disruption due to pelvic fractures were treated at Tri-Service General Hospital (TSGH) in Taipei, Taiwan. All patients received including mechanism of injury, associated complications and secondary operative procedures was recorded. Recurrence was determined using cystoscopy or retrograde urethrography and long-term voiding functions were determined using residual urine and uroflowmetry. Sexual functions were also determined using apatient questionnaire.
RESULTS: The mean age was 29.4 years (range 23-50 years). The mean interval between suprapubic cystostomy and transperineal urethroplasty was 5.6 months (range 4-9 months). The mean urethral stricture length was 2.8 cm (range 1.5-7 cm). During the follow-up period (range 17-73 months; mean 45.8), the overall postoperative re-stricture rate was 75% (6/8); 15 visual internal urethrotomies and 20 urethral dilations with sounds were performed subsequently. All eight patients now have patent urethras, and seven (87.5%) void well and are continent except one who has an underactive neurogenic bladder secondary to the injury. Erectile dysfunction (ED) was present both preoperatively and postoperatively in four (50%) of the patients. Of these, three had urethral re-stricture postoperatively.
CONCLUSIONS: In our experience, the principal problem was re-stricturing which can usually can be treated by secondary urethrotomy or dilation. Re-stricture of the urethra was easily noted in severely injured urethras. There were no changes in ED before or after operations. The long-term postoperative follow-up of voiding and sexual functions is mandatory.

並列關鍵字

urethral injury ； stricture ； urethroplasty