软性和硬性输尿管镜联合应用治疗尿道损伤16例报告

目的探讨联合应用软性和硬性输尿管镜治疗尿道损伤的疗效。方法2003年6月～2011年12月我院联合应用软性和硬性输尿管镜对16例尿道损伤实施腔内尿道会师术。耻骨上膀胱穿刺造瘘,沿造瘘管置人F_7.5软性输尿管镜,通过尿道内口达到尿道近断端。助手从尿道外口置入Wolf F8.0/9.8硬性输尿管镜,达到尿道远断端可见到软性输尿管镜头或亮光,从硬镜操作孔置入导丝,用软性抓钳将导丝钳入膀胱,撤出硬镜,沿导丝置入F18三腔气囊硅胶尿管,并经软性输尿管镜证实进入膀胱,气囊注水20m1,留置膀胱造瘘。结果7例球部尿道完全断裂,均会师成功;9例膜部尿道断裂,7例成功,2例失败。16例随访5～48个月,平均21个月,12例排尿正常,2例膜部损伤出现尿道狭窄,经尿道等离子电切后治愈,中转为开放手术的2例,术后常规定期尿道扩张,排尿正常,未出现尿道狭窄等并发症;3例有勃起功能障碍。结论双镜联合应用下行腔内尿道会师术,具有损伤小,并发症少,恢复快,手术操作简单,是治疗尿道损伤安全有效的方法。     

输尿管镜下尿道会师术治疗急性尿道损伤（附36例报告）

目的探讨输尿管镜下尿道会师术治疗急性尿道损伤的效果。方法 36例急性尿道损伤患者均在输尿管镜直视下行尿道会师术。结果 36例均一次性成功完成尿道会师术,术后平均4周拔出导尿管并按时行尿道扩张。均获随访,时间6个月～2年。术后6个月行膀胱镜和尿道造影复查,见尿道断端愈合良好,34例无狭窄或轻度狭窄,排尿正常,尿流率均在19 ml/s以上,1例因尿道严重狭窄实施尿道狭窄段切除端端吻合术,1例因尿线变细尿道扩张无效后行离子电切镜内切开。1例并发性功能障碍。结论输尿管镜下尿道会师术治疗急性闭合性尿道损伤具有操作简单、疗效可靠、创伤小、并发症少、恢复快等优点,值得临床应用。     

膀胱镜下尿道会师术治疗尿道损伤的临床分析

目的探讨膀胱镜下尿道会师术治疗尿道损伤的临床疗效。方法回顾性分析自2006年以来行膀胱镜下尿道会师术的12例尿道损伤患者的临床资料。结果 9例前尿道断裂行膀胱镜下尿道会师术成功,3例后尿道断裂会师失败后改开放手术治疗,术后均留置导尿管2～6周。随访6～30个月,均出现尿道狭窄,经尿道扩张后治愈。3例出现勃起功能障碍,其中2例经膀胱镜手术者半年后好转。结论膀胱镜下尿道会师术是急诊治疗尿道损伤的有效手段,创伤小、恢复快、效果满意。     

微创尿道会师术治疗尿道外伤(附31例报告)

目的:探讨微创尿道会师术治疗尿道损伤的疗效.方法:回顾分析为31例尿道损伤患者用输尿管镜行微创尿道会师术的临床资料,必要时联合应用膀胱造瘘并用金属导尿管辅助.结果:31例均获成功,18例患者经输尿管镜顺利置入斑马导丝及F18尿管,13例合并应用膀胱穿刺造瘘,应用金属导尿管辅助置入斑马导丝后顺利置入F18尿管.随访0.5...     

输尿管镜下铥激光治疗尿道狭窄65例临床分析

目的 探讨输尿管镜下结合铥激光技术尿道内切开治疗尿道狭窄及闭锁中的效果.方法 本院于2005年1月～2010年12月期间对65例尿道狭窄或闭锁的患者在输尿管镜下行铥激光尿道狭窄处内切开术,切除局部纤维瘢痕组织,修整尿道黏膜面,使管腔光滑;尿道闭锁者先行4号尿道探子经耻骨上膀胱造瘘口,沿膀胱前壁滑入尿道内口,然后经尿道置入输尿管镜与尿道探子对接.找到尿道后,将4号输尿管导管经输尿管镜插入膀胱内,输尿管镜随后穿越狭窄段进入膀胱内.铥激光放射状切开尿道狭窄环,并切除、修整尿道内面瘢痕组织,使管腔光滑,直至顺利通过20号尿道探子.结果 所有患者手术过程均顺利,55例一次手术治愈,4例经多次尿道扩张后治愈,4例在术后3个月至1年再次尿道狭窄,行铥激光内切开后治愈,2例3次铥激光内切开手术后治愈.术后前尿道瘘1例,持续导尿后自愈.术后3个月、6个月平均最大尿流率分别为(22.3±3.3)ml/s,(20.1 ±2.5)ml/s.结论 输尿管镜结合铥激光行尿道内切开加瘢痕切除术是治疗尿道狭窄及闭锁安全、创伤小、并发症少,疗效显著,有效的治疗方法.     

腔内尿道会师法治疗复杂性男性尿道狭窄

目的总结腔内尿道会师法治疗复杂性尿道狭窄的经验。方法16例男性复杂性尿道狭窄患者,术前行耻骨上膀胱造瘘术,硬膜外麻醉下经尿道外口置入尿道内切开镜,经耻骨上膀胱造瘘口置入一软性膀胱镜经膀胱颈口顺行进入尿道。经内切开镜或软性膀胱镜插入一细输尿管导管,经正道通过狭窄段尿道。沿此导管用内切开刀切开狭窄段尿道,沿正道进入膀胱,再用Otis刀彻底切开狭窄段。结果16例患者均成功地顺利完成了腔内尿道会师手术,拔除尿管后排尿通畅。平均手术时间122min。平均最大尿流率18mL/s。随访15月,F20尿道扩张器可以顺利通过。结论利用内切开镜和软性膀胱镜腔内尿道会师治疗复杂性尿道狭窄,方法简单易行,疗效确切可靠,成功率高。     

输尿管镜下早期尿道会师术治疗外伤性尿道断裂的体会（附13例报告）

2008～2012年，输尿管镜治疗外伤性尿道断裂13例。受伤时间1～8h，平均3．2h。术中见部分断裂5例，完全断裂8例，行输尿管镜探查，放置超滑黑泥鳅导丝进入膀胱，引导F33三腔尿管入膀胱，完成会师术。术后患者均恢复正常排尿，手术时间30～55min，平均40min。随访12～24个月，平均13．8月。12例最大尿流率18～24ml／s，1例12ml／s。     

膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄(附12例报告)

目的:评估膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄的临床疗效。方法:采用膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄男性患者12例,中位年龄33(19～54)岁。术前行尿道探子会师+尿道造影对狭窄部位和长度进行评估,经造瘘口置入膀胱软镜探及尿道内口,经尿道外口置入尿道内切开镜并调暗光源,在膀胱软镜光源引导下行尿道狭窄内切开术,并对手术时间、失血量、并发症进行记录。术后留置尿管1个月,拔除尿管后每月进行随访,术后3个月行尿道造影、尿流率及国际勃起功能指数问卷(IIEF)评分评估。结果:手术均获成功,手术时间(37±12)min,手术后血红蛋白较术前降低(4.5±2.3)g/L,拔除尿管后无尿失禁,术前术后IIEF评分无明显变化(12.4±6.6vs 13.1±7.0,P>0.05)。随访6～22个月,9例无需进一步处理,排尿正常;3例拔除尿管后出现排尿困难和继发性尿道狭窄,给予每周1次尿道扩张,2例连续4周、1例连续6周尿扩后可置入F18尿道探子,排尿正常,术后3个月Qmax均在(16.2±5.8)ml/s以上。结论:膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄简便易行,创伤小,并发症少,近期及远期疗效满意,可作为骨盆骨折术后尿道狭窄的首选治疗方法。     

输尿管镜下尿道置管会师术治疗尿道断裂八例

目的探讨输尿管镜下行尿道置管会师术治疗尿道断裂的临床效果和使用价值。方法对2008年10月至2011年2月间经输尿管镜下行尿道置管会师术治疗尿道断裂的病例进行回顾性分析;输尿管镜下经尿道外或内口置入导丝至膀胱,再经导丝引导插入Foley导尿管牵引固定,引流尿液2～4周后拔管。结果 8例全部手术成功,7例经尿道外口置管,另1例经尿道内、外口双向置管。前尿道不完全断裂2例,后尿道完全断裂6例。手术时间10～45min。术后随访6～12个月,6例排尿通畅,2例因尿线变细疑有尿道瘢痕狭窄定期行尿道扩张后痊愈,无尿瘘、假道、尿失禁和明显性功能障碍。结论输尿管镜下尿道置管会师术操作简单、手术时间短、对患者创伤小、术后恢复快、效果确切、并发症少。可同时解除尿潴留并恢复尿道连续性,适合各种生命体征平稳的尿道断裂的早期治疗,值得临床推广。     

膀胱镜下尿道会师术治疗尿道损伤临床分析:附11例报告

目的探讨膀胱镜下尿道会师术治疗尿道损伤的临床疗效。方法回顾分析自2007年以来我科11例尿道损伤患者施行膀胱镜下尿道会师术的临床资料。结果 10例尿道断裂行膀胱镜下尿道会师术成功,1例尿道会师术失败改开放手术,术后均留置尿管3~6周。拔除尿管后继续行尿道扩张术1次/周,共6次。随诊6~12个月,患者均未出现尿道狭窄、尿线变细或排尿困难。结论膀胱镜下尿道会师术是治疗尿道断裂的有效方法,具有创伤小、恢复快、疗效满意的优点,值得推广应用。     

尿道会师术后三腔气囊尿管的留置时间探讨

目的:探讨尿道会师术后三腔气囊尿管的合理留置时间。方法:报告65例后尿道断裂患者Ⅰ期尿道会师术后,三腔气囊尿管牵引和留置时间及尿道扩张情况。结果:23例尿道会师术后尿管留置3周,均有不同程度的尿道狭窄,需定期做尿道扩张;其中15例扩张达1年之久,3例行尿道内切开术加定期尿道扩张。20例术后留置三腔气囊尿管3个月,一次治愈7例;6例轻度尿道狭窄者,尿道扩张3～5次痊愈;其余较严重者均需扩张半年以上。22例术后尿管留置6个月,一次痊愈15例;4例轻度狭窄者,尿道扩张3～4次痊愈,其余3例狭窄者,尿道扩张3个月至半年痊愈。结论:尿道会师术后三腔气囊尿管留置时间的长短,将直接影响尿道狭窄的发生率和狭窄程度,较为合理的留置时间以6个月为宜。     

双窥镜尿道会师术早期治疗尿道损伤的疗效观察（附23例报告）

目的：探讨双内窥镜尿道会师术早期治疗尿道损伤的临床疗效.方法：回顾性分析23例尿道损伤患者采用输尿管软镜及尿道膀胱镜进行双内窥镜下尿道会师术的早期治疗经验.结果：23例损伤尿道在双内窥镜直视下会师均获得成功,全部患者无尿失禁,其中20例维持良好性功能.随访1～3年,18例无需进一步处理,尿流率正常;另5例出现短程排尿困难和继发性尿道狭窄,经短期定期尿道扩张或尿道内切开后,排尿正常.结论：双窥镜下尿道会师术早期治疗尿道损伤具有手术方式简单、手术时间短、微创、并发症少的优点,可有效用于男性闭合性尿道损伤的治疗,尤其是后尿道完全断裂及骨盆骨折患者.     

改良尿道拖入术治疗外伤性后尿道狭窄36例疗效分析

目的:探讨中号硅胶引流管作为牵引固定装置的改良尿道拖入术,治疗外伤性后尿道狭窄或闭锁的效果。方法:2001年1月～2005年6月我科采用此方法治疗复杂外伤性后尿道狭窄或闭锁患者36例。其中25例为骨盆骨折外伤后1期尿道会师术术后尿道闭锁,余11例为骨盆骨折外伤后仅行膀胱造瘘术。尿道狭窄长度1.0～4.5cm,平均2.2cm。患者年龄17～59岁,平均44.5岁。术前并发ED9例。结果:术后随访1年,25例排尿通畅,无需尿道扩张;6例术后需行尿道扩张3～6次;3例术后需定期尿道扩张1年以上(1～3个月扩1次);2例失败。手术中无1例需要输血,术后ED患者无增加,无术后尿失禁发生。结论:改良尿道拖入术操作简单,手术效果好,损伤小,无ED、尿失禁发生。     

创伤性后尿道损伤的腔镜治疗(附18例报告)

目的探讨输尿管镜在骨盆骨折后尿道断裂治疗中的临床价值。方法对18例男性骨盆骨折后尿道断裂患者施行输尿管镜下尿道会师治疗。结果12例患者采用逆行法，6例采取顺行法完成尿道会师，手术均获成功且排尿正常。9例1个月后排尿造影检查，9例3个月后尿道镜检查，未发现尿道狭窄。1例3个月时出现尿线细缓，予间歇扩张6个月后治愈。全组性功能均恢复，无尿失禁发生。结论输尿管镜下尿道会师术实现了骨盆骨折后尿道断裂的微创治疗，有效减少了术后并发症。手术具有操作相对简便、省时的优点。     

腔镜下处理闭合性尿道损伤（附16例报告）

[摘要] 目的： 探讨腔镜在处理闭合性尿道损伤中的应用。方法: 回顾分析我院自2001年6月至2009年6月16例闭合性尿道损伤患者通过腔镜下处理的临床资料。结果：16例患者均通过腔内治疗获得成功,术后随访6个月～2年, 12例患者排尿顺畅,尿线较前无明显变细,4例患者,其中3例骨盆骨折伤,1例尿道球部完全断裂,拔除尿管1周-2月后不同程度出现尿线变细,经尿道造影检查发现不同程度的尿道狭窄,予行尿道扩张2-4个月后排尿顺畅。本组全部患者无勃起功能障碍发生。结论：腔镜下处理闭合性尿道损伤具有疗效好、创伤小、手术时间短、并发症少等特点。     

The effectiveness of early primary realignment in children with posterior urethral injury

AIM: The aim of this retrospective study was to compare the results of delayed repair and early primary realignments in patients with posterior urethral injury. METHODS: From 1990 to 2003, 20 children were admitted to the Medical Faculty of Uluday University, Bursa, Turkey, for posterior urethral injuries. Traffic accidents were the most common cause of injury (n = 17). Twelve patients (60%) who were referred early (1-10 days) underwent early realignment over a urethral tube. A total of eight patients (40%) underwent delayed repair using transpubic route. In these patients, surgical repair of the urethra was performed 5-6 months later. RESULTS: Of the 12 patients who underwent early urethral realignment, six required at least one visual internal urethrotomy following the removal of the urethral catheter. Urethral stricture developed in two of 12 patients (16.6%) who underwent early urethral realignment. Of the eight patients who underwent delayed repair, six required at least one visual internal urethrotomy following removal of the urethral catheter. Urethral stricture developed in three of eight patients (37.5%) who underwent delayed repair. This difference was statistically significant (P < 0.05). CONCLUSION: The urethral stricture in patients who underwent early primary realignment was less developed than the stricture that developed in those who underwent delayed management. According to these results we recommend early primary realignment in children with posterior urethral injury.     

带蒂大网膜移位治疗复杂性后尿道狭窄(附六例报告)

目的　探讨带蒂大网膜移位治疗复杂性后尿道狭窄的临床疗效。　方法　复杂性后尿道狭窄 6例 ,均为男性 ,年龄 14～ 4 5岁 ,平均年龄 2 6岁。车祸伤 5例 ,坠落伤 1例。病程 6个月～ 5年 ,平均 2 .5年。狭窄段长 3.0～ 5 .5cm。合并尿道直肠瘘 2例 ,膀胱结石 1例 ,耻骨后死腔 3例。均采用经耻骨联合径路修补加带蒂大网膜移位术治疗。　结果　 6例患者均一次手术成功 ,4周后拔除导尿管均能自行排尿 ,无尿失禁及尿路感染。随访 6～ 38个月 ,平均 2 6个月。 4例排尿良好 ,不需尿道扩张 ;2例 3个月内再次出现不同程度的尿线变细、排尿困难 ,经 3～ 2 4个月的尿道扩张后治愈。　结论　带蒂大网膜移位治疗适用于尿道狭窄段较长或伴有尿道直肠瘘、假道等的复杂性后尿道狭窄 ,尤其是既往经会阴途径后尿道修复手术失败者 ,是修补复杂性后尿道狭窄较为理想的方法之一。     

The value of immediate or early catheterization of the traumatized posterior urethra.

A total of 16 patients with posterior urethral ruptures was treated with the aim of reestablishing urethral continuity immediately or early after injury. Followup ranged from 13 to 83 months (average 27). In all patients an emergency retrograde urethrogram demonstrated extravasation from the posterior urethra. Of the patients 13 were treated with a urethral catheter either immediately or within 1 to 5 weeks after injury. Three patients were treated with a suprapubic catheter alone after unsuccessful attempts at reestablishing urethral continuity and all 3 subsequently required urethroplasty for an obliterative stricture. These 3 patients were also impotent after injury. Of the 13 patients treated with a urethral catheter 8 had the catheter inserted either retrograde (2) in the emergency room or antegrade (6) in the operating room just after the injury, and in 5 the catheter was inserted transurethrally at cystoscopy within a mean of 3 weeks after injury. A total of 7 patients (54%) treated with urethral catheterization had a stricture during followup: 4 responded well to internal urethrotomy and 3 required simple dilation. Of 12 patients 5 (42%) became impotent after injury, while 1 was impotent before injury. No patient became incontinent. We conclude that careful urethral catheter realignment either immediately or within 5 weeks after injury is safe and obviates total urethral closure. Impotence may result from the severity of the injury and not from management with catheterization.     

Deferred endoscopic urethral realignment: Role in management of traumatic posterior urethral disruption

ObjectivesThe aim of our study is to assess the value of deferred endoscopic urethral realignment after traumatic posterior urethral disruption.Patients and methodsBetween June 2001 and August 2011, we evaluated 28 patients who presented 3–6 weeks (mean 27 ± 6 days) after experiencing traumatic posterior urethral disruptions and pelvic fractures; immediate and early realignment were overdue in these cases. Patient variables included mode of presentation, mechanism of trauma, type of pelvic fracture, and Abbreviated Injury Scale (AIS). Under fluoroscopic guidance, a guidewire was passed into the injured urethral segment from the distal to proximal injured ends using a long Chiba needle, and realignment was performed using endoscopic urethrotomy. The follow-up period ranged from 18 to 98 months (mean 43 ± 22.5 months).ResultsAfter the procedure, 46% of patients were stricture free. After one visual internal urethrotomy (VIU) and two VIU's, 60% and 64% of patients were stricture free. No cases of post-procedural incontinence occurred, and impotence was reported in only 14% of patients. Type of pelvic fracture was the only variable that significantly affected the success rate, where the success rate decreased from 100% in stable pelvic fracture to 25% in bilateral rotationally and vertically unstable pelvic fracture.ConclusionWhen early realignment is postponed for any reason, deferred endoscopic realignment is considered an adequate substitute because urethral continuity can be achieved in a group of patients without increase incidence of impotence and incontinence.