尿道套入法治疗 小儿外伤性后尿道狭窄或闭锁17例

目的探讨尿道套入法治疗小儿外伤性后尿道狭窄或闭锁的疗效。方法使用尿道套入法治疗小儿外伤性后尿道狭窄或闭锁共17例,均为男性,平均年龄9岁,尿道瘢痕长约0．5～2．5cm。结果术后16例排尿通畅,无尿失禁。1例术后出现排尿困难,经尿道扩张处理后治愈。结论本方法操作简单,手术时间短,效果好,是治疗小儿外伤性后尿道狭窄或闭锁较佳的手术方法。     

尿道套入法治疗小儿外伤性后尿道狭窄事闭锁17例

目的 探讨尿道套入法治疗小儿外伤性后尿道狭窄或闭锁的疗效。方法 使用尿道套入法治疗小儿外伤性后尿道狭窄或闭锁共１７例,均为男性,平均年龄９岁,尿道瘢痕长约０．５－２．５ｃｍ,结果 术后１６例排尿通畅,无尿失禁。１例术后出现排尿困难,经尿道扩张处理后治愈。     

尿道内切开术治疗男童外伤性尿道狭窄

目的　探讨应用尿道内窥镜下尿道内切开术 ,治疗男童外伤性后尿道瘢痕性狭窄的效果。方法　回顾性总结 2 1例陈旧性外伤性后尿道狭窄患儿 ,经尿道内切开术治疗的结果 ,分析手术方法、术中注意事项、手术成功率等。结果　 2 1例中 ,12例经 1次尿道内切开治愈 ,6例经 2次手术治愈 ,1例经 3次手术治愈 ,最终由尿道内切开术治愈 19例 ,成功率为 90 .5 % ,患儿排尿顺畅 ,尿流率正常。结论　经尿道镜下尿道内切开术治疗男童外伤性后尿道狭窄 ,是一种微创、简便、安全、有效的方法     

经会阴途径后尿道吻合术治疗小儿外伤性后尿道狭窄

目的　探讨会阴途径后尿道吻合术治疗小儿外伤性后尿道狭窄的适应证、手术原则、并发症。方法　经会阴途径后尿道吻合术治疗小儿外伤性后尿道狭窄或闭锁 35例。结果　随访 2 8例 ,随访率 80 .0 %。2 8例共治愈 2 1例 ,治愈率 75 .0 %。结论　经会阴途径尿道吻合术可作为开放手术治疗小儿外伤性后尿道狭窄的首选术式 ;彻底切除尿道周围瘢痕达到黏膜对黏膜无张力吻合是手术的关键 ;对后尿道狭窄闭锁段长者 ,加用长直针吻合法 ,可取满意的疗效。     

经会阴修复男童急性外伤性后尿道断裂

目的 探讨经会阴尿道吻合术治疗男童急性外伤性后尿道断裂的效果.方法 总结1994至2007年我院采用经会阴尿道吻合术修复男童急性完全性尿道断裂共24例资料,年龄4～15岁,平均6.5岁,本组后尿道损伤均因骨盆骨折导致,在牛命体征平稳的情况下,手术时问为外伤后10 h至7 d.经术前自尿道外口造影诊断后尿道完全性断裂.所有病例均急诊行经会阴尿道端端吻合术.术后留置导尿管2～4周.结果 24例新鲜尿道外伤除1例手术后有尿道狭窄,手术后3个月做内切开;另外1例手术后随诊有轻微压力性尿失禁外,其余病例一次手术均获成功,排尿良好.结论 经会阴修复男童急性外伤性后尿道断裂效果满意.     

女孩尿道损伤

目的　探讨女孩尿道损伤的早期及晚期并发症的有效治疗方法。方法　对我院收治的女孩尿道损伤的治疗效果进行回顾分析。结果　 18例中 ,急诊住院 8例 ,晚期并发症 10例。年龄 2～ 12岁。伴有骨盆骨折 16例 ,阴道损伤 18例 ,伴直肠损伤 4例。急诊住院者中均进行了早期修补 ,6例Ⅰ期治愈 ,2例并发尿道阴道瘘 ,Ⅱ期修补成功。晚期 10例中 ,尿道阴道瘘 6例 ,经阴道修补 4例1次成功 ,2例 2次修补成功 ,另 2例近端尿道闭锁 ,采用近端尿道套入法修补成功。余 2例尿瘘伴阴道狭窄 ,经阴道成形后经阴道尿瘘修补成功 1例。另 1例阴道成形后再次狭窄 ,正等待治疗中。结论　早期手术修补或恢复正常的解剖关系是避免和减少其并发症发生的重要手段 ,晚期并发症多为尿道阴道瘘 ,大多可经阴道修补 ,近端尿道闭锁治疗困难 ,其手术路径及术式应据术者经验和病情选择。     

经耻骨会阴联合途径治疗男童复杂性后尿道狭窄或闭锁

目的：评价经耻骨会阴联合途径治疗男童复杂性后尿道狭窄或闭锁的临床疗效。方法：15例复杂性后尿道狭窄或闭锁的男童均行经耻骨会阴联合途径后尿道端端吻合术，其中3例合并尿道直肠瘘，结果：15例均一次手术成功，术后均能自主排尿，排尿通畅，10例术后最大尿流率（MFR）平均12．5ml/s，3例术后有尿失禁现象，其中2例6个月后尿失禁现象明显改善，11例随访6－36个月，排尿仍通畅，无需尿扩，步态平衡，结论：该术式适于尿道狭窄段较长或伴有尿道直肠瘘，假道等复杂性后尿道狭窄，尤其是以往经会阴途径后尿道修复手术失败者。     

儿童外伤性后尿道狭窄或闭锁的手术治疗

目的　总结儿童外伤性后尿道狭窄或闭锁的手术治疗的体会。方法　后尿道损伤术后再狭窄或闭锁 38例患儿 ,其中经会阴尿道修复术 3例 ,经耻骨会阴联合尿道修复术 2 6例 ,经耻骨尿道修复术 4例 ,带蒂阴囊皮管代尿道 4例 ,经会阴和尾路尿道吻合及尿道直肠瘘修补术 1例。结果　38例患儿随访 1～ 8年 ,其中排尿正常者 34例 ( 89.5 % )。 1例经耻骨会阴联合尿道修复术尿失禁 ;2例经耻骨尿道修复术再次尿道狭窄 ;1例带蒂阴囊皮管代尿道术后排尿通畅 ,同时合并尿道会阴瘘。结论　①经耻骨会阴联合切口手术途径更适合于复杂性外伤性后尿道狭窄或闭锁的小儿 ;②顺行和逆行尿道造影时可能过多估计尿道狭窄的长度 ;③经会阴尾路联合途径对尿道直肠瘘修补失败者不失为一个好的选择     

经尿道内切开治疗男童后尿道狭窄与闭锁

探讨经尿道内切开治疗男童外伤性后尿道狭窄与闭锁的适应证及记忆合金支架的应用。材料与方法１；５３例患儿年龄４－１２岁，平均７岁，狭窄３５例，闭锁１８例。其中切开后放置钛镍螺遽记忆合金支架２３例。结果；随访３个水－８年。未放记忆合金支架组治愈２３例，好转３例，尿失禁３例，改开放手术１例；放置记忆合金支架台愈７例，好转１例，带支架正常排尿８例，改开放手术７例。结论；本法适用于治疗短段尿道狭窄或闭锁，狭窄     

儿童后尿道损伤的诊断与治疗

目的　探讨儿童后尿道损伤更为有效的诊治方法和并发症的防治。方法　回顾性总结分析 1990年 4月～ 2 0 0 3年 12月四川大学华西医院收治的 5 5例儿童后尿道损伤的临床资料 ,38例( 6 9.0 % )获得 6个月～ 14年 (平均 6年 4个月 )的随访。结果　本组几乎均为陈旧性后尿道损伤。尿道狭窄组 10例行尿道带管扩张 ,7例治愈 ,3例改行尿道拖入吻合术 ;尿道闭锁组 ,采用后尿道拖入吻合术 2 9例 ,近期成功率 10 0 % ,远期结果 ,排尿欠通畅 3例 ,部分性尿失禁 4例 ,反复发生附睾炎 2例 ,阳痿 2例 ;经耻骨后尿道成形术 14例 ,近期成功率 86 % ,远期结果 ,排尿困难 2例 ,排尿欠通畅 2例 ,不完全性尿失禁 2例 ,附睾炎 1例 ,阳萎 1例 ;3例阴囊中缝皮瓣拖入间置术中 ,2例发生间置尿道狭窄 ;2例经会阴尿道吻合术疗效满意。结论　尿道狭窄经恰当处理后会有良好的效果 ;经会阴后尿道拖入吻合术在儿童后尿道闭锁的治疗中效果满意 ,经耻骨后尿道吻合术更适用于较复杂的后尿道闭锁治疗 ;我们赞同儿童后尿道断裂伤后早期即时的耻骨上膀胱造瘘 ,延期尿道修复手术的观点     

Post-traumatic posterior urethral stricture in children: how to achieve a successful repair

ObjectiveComplex post-traumatic posterior urethral strictures in children constitute a major challenge to the pediatric urologist. Surgical repair depends primarily on the length of the urethral obliteration. Resection with end-to-end anastomosis is the usual procedure in the face of a short segment stricture. Transpubic urethroplasty and substitution urethroplasty are currently used to treat extensive and complex urethral strictures. We present our experience of the management of children presenting with post-traumatic posterior urethral stricture.Patients and methodsFifty boys with a mean age of 9 years (6–13) with obliterative urethral stricture were operated on during May 1999 to August 2006. Short posterior urethral stricture was treated by excision and end-to-end anastomotic urethroplasty in 40 boys. Long posterior urethral stricture was managed by combined inferior pubectomy in three, transpubic urethroplasty in four and tubed penile fasciocutaneous flap in three.ResultsWith a mean follow-up of 4.5 years (6 months–7 years), all children who underwent perineal anastomotic urethroplasty were successfully repaired. Transpubic urethroplasty was associated with a re-stricture in one child 6 years following the repair. In the group repaired by tubed fasciocutaneous flap, we encountered a distal anastomotic stricture accompanied by a huge proximal diverticulum which needed revision in one child, and another diverticulum with multiple stones in another who was treated successfully.ConclusionAnastomotic urethroplasty in children is feasible with good results. Proper evaluation is needed to choose the best surgical technique for each patient. Tubed fasciocutaneous flap carries the highest complication rate.     

Congenital posterior urethral obstruction: re-do fulguration

In patients with congenital posterior urethral obstruction, transurethral fulguration (TUF) is usually the treatment of choice if the patient is in a stable condition. However, few papers have described the proportion of patients who need further fulguration. We reviewed 83 boys with a congenital obstructive posterior urethral membrane (COPUM) to assess the role of re-do fulguration, as judged by prospective video recordings. Between December 1990 and March 2000, 83 boys (aged from newborn to 15 years) underwent cystourethroscopy for investigation of a urethral anomaly and were found to have a COPUM. TUF was performed endoscopically with a hook diathermy electrode. Two to 3 months later boys who had cauterisation had a further urethroscopy and diathermy as required. Of the 83 membranous lesions in the posterior urethra, 38 were considered severe, 20 moderate, and 21 minor. Four patients had inadequate data to be properly classified. Eighteen (47.4%) of the 38 patients who had a severe obstructive membrane equired further endoscopic intervention to obliterate residual membrane elements. As over 45% of patients who had a severe obstructing membrane needed further fulguration, it is important to follow patients carefully and to repeat the cystourethroscopy.     

Correlation of cystographic bladder morphology and neuroanatomy in boys with posterior urethral valves

Purpose. We have observed a difference in the radiographic appearance of the body of the bladder (trabeculated) and its base (smooth) in boys with severely obstructing posterior urethral valves. We wanted to determine if (1) this was a reproducible finding and (2) there was an anatomic and/or physiologic explanation for it. Materials and methods. We reviewed the initial voiding cystourethrogram in 47 boys with severe posterior urethral valves. The interureteric ridge was used as the division between the body and base of the bladder. The presence of trabeculation for each region was recorded. Results. Ages ranged from 1 day to 6 years at the time of initial cystographic evaluation (median 14 days). The body of the bladder was trabeculated and the base smooth in 72 % (34 patients). In the remaining patients, both the body and base were smooth. In no patient was the base trabeculated. Conclusions. The cystographic morphology of the urinary bladder in boys with posterior urethral valves can be explained by its neuroanatomy. The body of the bladder, which contracts during voiding because of parasympathetic (cholinergic) stimulation, becomes trabeculated. The bladder base relaxes during voiding due to sympathetic (alpha adrenergic) stimulation and remains smooth. Thus, this difference in the cystographic appearance of the two parts of the urinary bladder reflects the normal innervation and the mechanics of micturition in boys with urethral obstruction. Received: 12 July 1996 Accepted: 6 November 1996     

Blunt pediatric anterior and posterior urethral trauma: 32-year experience and outcomes

ObjectiveTo analyze our experience with delayed repair of pediatric urethral trauma.Materials and methodsFrom 1978 to 2007, 26 boys <18 years old (mean age 15.0) presented for delayed repair of urethral stricture after blunt trauma. Anterior and posterior urethral injuries were separately stratified.ResultsThere were 8 anterior and 18 posterior urethral strictures. All patients presented in a delayed fashion. Mean follow up of the anterior cohort was 2.9 years. All repairs were performed via a ventral onlay buccal graft or anastomotic approach. The mean follow up of the posterior cohort was 1.1 years, and all posterior urethral injuries were repaired via an anastomotic approach.Overall success for anterior stricture disease was 88.9% and for posterior stricture disease was 89.5%. All three urethroplasty failures responded favorably to internal urethrotomy; however, one failed anterior repair and one of the two failed posterior repairs required two internal urethrotomy operations for success. No secondary urethroplasty operations were required and ultimately all patients were voiding per urethra without need for urethral dilation.ConclusionDelayed, definitive repair of pediatric urethral trauma via open urethroplasty has a high success rate.