输尿管镜下尿道会师术治疗急性闭合性尿道损伤尿道临床体会

目的分析输尿管镜下尿道会师术治疗急性闭合性尿道损伤的效果。方法回顾性分析对21例急性闭合性尿道损伤患者实施输尿管镜下尿道会师术的临床治疗资料。结果 21例患者均成功实施手术,手术时间(27.62±9.15)min,平均尿流速率为20 m/s。19例患者拔出尿管后排尿通畅、2例拔管1~3个月后尿线细小,1例不定期行尿道扩张后治愈。1例尿道扩张无效后行离子电切镜内切开后恢复自行排尿。随访6个月~2 a,未出现无尿失禁、性功能障碍等。结论在输尿管镜下实施尿道会师术治疗急性闭合性尿道损伤,操作简单、创伤小、术后恢复快,并发症少。     

输尿管镜、尿道镜下腔内尿道会师术治疗尿道损伤28例

目的探讨输尿管镜、尿道镜下腔内尿道会师术治疗尿道损伤的疗效。方法 2006年1月～2011年1月采用输尿管镜、尿道镜下尿道会师术治疗尿道损伤28例,经尿道输尿管镜探查明确损伤部位,对损伤较轻者,输尿管镜探查后直接进入膀胱,在输尿管支架管引导下置入F18～F20完成尿道会师;对输尿管完全断裂者,输尿管镜明确后行膀胱造瘘,在尿道镜引导下行输尿管支架管引导从尿道外口置入F18～F20尿管完成尿道会师,术后对尿道狭窄者定期尿道扩张。结果 28例均一次性成功,手术时间5～36 min,平均16 min。术中见尿道黏膜挫伤4例、球部尿道后壁穿孔4例、后尿道黏膜撕裂伤4例、尿道部分撕裂伤10例、尿道完全断裂伤6例,4例合并前列腺增生。23例随访3～36个月,平均27个月,其中20例随访〉24个月：术后均恢复正常排尿,最大尿液率17～22 ml/s,平均20 ml/s;9例尿道狭窄分别行冷刀内切开（3例）和直视下尿道扩张（6例）。结论经尿道腔镜下会师术操作简单,患者痛苦小,尿道排尿功能恢复良好。     

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。     

急诊输尿管镜下尿道会师术治疗尿道球部损伤

目的探讨输尿管镜下尿道会师术治疗尿道球部损伤的应用价值。方法 25例全部为骑跨伤,所有患者均行输尿管镜下尿道会师术。结果 25例全部1次手术治疗成功,6～12个月后尿流动力学检查,最大尿流率皆大于15ml/s,无尿瘘、尿失禁和阴茎勃起功能障碍。结论采用输尿管镜下尿道会师术治疗尿道球部损伤,创伤小、手术及住院时间短、恢复快、费用低等优点,值得临床推广。     

输尿管镜下尿道会师术治疗尿道损伤

目的探讨输尿管镜下尿道会师术在尿道断裂中的应用价值。方法回顾分析16例尿道会师术治疗尿道损伤的临床资料。结果16例手术成功,随访3个月～2年,其中排尿通畅、尿线粗,不再需要尿道扩张12例;排尿尚通畅,但仍需定期尿道扩张,无残余尿3例,1例由于术后没有定期尿道扩张3～4个月出现尿道狭窄改行尿道内冷刀切开加电切术后治愈。均无性功能异常、尿失禁。结论输尿管镜下尿道会师术手术时间短、创伤小、恢复快、效果佳,是优于传统开放尿道会师术的理想方法,合理选择病人可取得较好的治疗效果。     

输尿管镜尿道会师术治疗尿道断裂的临床探讨

目的:探讨输尿管镜尿道会师术治疗尿道断裂的临床效果和应用价值。方法:对2008年3月~2012年3月期间我院输尿管镜尿道会师术治疗的21例男性尿道断裂患者的临床资料进行回顾性分析;镜下经尿道外口或内口向尿道断裂近侧或远侧断端放置导丝,循导丝引导留置Foley导尿管牵引固定2~4周,恢复尿道连续性,引流尿液。结果:所有手术全部成功,15例经尿道外口置管,6例联合肾镜经尿道内、外口双向置管。手术时间10~50min。术后随访6~18个月,18例排尿通畅,3例尿线变细考虑尿道狭窄,其中2例定期行尿道扩张,1例行尿道狭窄内切开后定期尿道扩张,均痊愈恢复。无感染、尿瘘、尿失禁及明显性功能障碍。结论:输尿管镜尿道会师术治疗尿道断裂创伤小、手术时间短、可视化、简便快捷、并发症少、安全有效,是一种值得推荐的微创治疗方法。     

输尿管镜下尿道内会师术治疗尿道损伤12例体会

目的探讨输尿管镜尿道内会师术治疗闭合性尿道损伤的临床价值。方法回顾分析12例尿道损伤施行输尿管镜尿道内会师术的临床资料。结果 12例输尿管镜尿道会师术均一次性成功,7例术后排尿通畅,4例行尿道扩张数次后排尿通畅,1例尿道狭窄外院再行手术治疗,均无性功能障碍。结论输尿管镜下尿道内会师术创伤小,恢复快,是治疗闭合性尿道损伤的一种有效方法。     

内窥镜下尿道会师术治疗急性闭合性尿道损伤42例疗效观察

目的:探讨内窥镜下尿道会师术治疗急性闭合性尿道损伤的临床疗效。方法:回顾性分析42例急性闭合性尿道损伤患者采用输尿管镜进行内窥镜下尿道会师术的临床治疗效果。结果:42例损伤尿道在内窥镜下全部会师成功,均无尿失禁。36例无需进一步处理,尿流率正常;6例经间断尿道扩张后,尿流量正常。随访0.5～2年,41例排尿正常,1例失访。结论:内窥镜应用于男性急性闭合性尿道损伤,具有手术时间短、创伤小、康复快、疗效好等优点,可以作为男性急性闭合性尿道损伤治疗的首选方法。     

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。     

输尿管镜在急诊导尿失败的闭合性尿道损伤早期处理中的应用(附21例报告)

目的:探讨输尿管镜在早期处理急诊导尿失败的闭合性尿道损伤的可行性及其应用价值。方法:采用输尿管镜辅助下留置导尿管行尿道会师术,治疗21例急性闭合性尿道损伤患者,其中球部损伤14例、后尿道损伤7例。术后对患者进行随访并收集临床资料。结果:21例急性闭合性尿道损伤患者均成功在输尿管镜辅助下行尿道会师术,其中5例患者同时行膀胱穿刺造瘘术。术后随访0.5～6年,有5例患者因狭窄尿道行尿道内切开术。结论:对于急性闭合性尿道损伤,采用输尿管镜早期处理可取得较好效果。     

尿道镜在急性闭合性尿道损伤治疗中的应用价值（附22例报告）

目的：探讨尿道镜在急性闭合性尿道损伤治疗中的应用价值。方法：对因骑跨伤致闭合性尿道球部损伤患者13例和骨盆骨折致后尿道损伤患者9例，采用电视尿道镜下留置导尿管行尿道会师术。结果：球部损伤患者12例会师成功，1例进镜失败；后尿道损伤患者5例会师成功，4例失败。随访0．5～5年，15例治愈，1例复发狭窄，1例失访。结论：采用尿道镜下尿道会师术治疗前尿道损伤安全合理，创伤小，疗效好，应成为首选方法；治疗后尿道损伤则需慎重，应根据伤情试行腔镜治疗。     

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.     

The closed injuries of the lower urinary tract: problems of the X-ray diagnostics

The closed injuries of the lower urinary tract: problems of the X-ray diagnostics. Results of X-ray investigation were analyzed in 54 patients with urinary bladder trauma and 23 patients with urethral injuries. There were no false conclusions during urography in 23 patients with urethral injuries. In one patient urography was carried out in late terms due to the underestimation of urether trauma by the time of admission to the hospital. Cystography was carried out in 38 out of 54 patients to exclude bladder trauma. Presence of trauma was confirmed in 36 (94,7%) cases. False conclusion about the absence of bladder rupture was given in 2 (5,26%) cases. Type of rupture was misdiagnosed in 5 (13,1%) patients leading to increased extent of operation in 1 case. The reasons for the false conclusions were misconduction of investigation technique and underestimation of the obtained X-ray data.     

Pelvic fracture-associated urethral injuries in girls: experience with primary repair

OBJECTIVE: To present our experience with four urethral injuries in females accompanying a pelvic fracture, managed with primary repair or realignment of the urethra. PATIENTS AND METHODS: There were three teenage girls and one adult (22 years old). All the patients had complete urethral injuries associated with a pelvic fracture from accidents. They were managed by immediate suprapubic cystostomy followed by repair or realignment of the urethra over a catheter on the same day. The catheter was removed after 3 weeks and a voiding cysto-urethrogram taken. Thereafter they were followed with regular urethral calibration. RESULTS: All patients voided satisfactorily with a good stream; three were fully continent and the fourth had transient stress urinary incontinence. One patient needed dilatation at 2 months and another visual internal urethrotomy at 5 months. At a mean (range) follow-up of 33 (9-60) months all the patients had a normal voiding pattern and were continent; none developed vaginal stenosis. CONCLUSION: Primary repair of the urethra, and if that is impossible, simple urethral realignment over a catheter, is the procedure of choice for managing female urethral injury associated with a pelvic fracture. The procedure has the additional advantage of reducing the risk of vaginal stenosis.     

Urethral injury due to external trauma

Fifty-six patients with urethral injuries comprised 35 involving the posterior urethra and 21 involving the anterior urethra. Immediate retrograde urethrography confirmed the clinical diagnosis made when blood was found at the external urinary meatus after external trauma. Traffic accidents caused most of the posterior urethral injuries and were associated with severe injuries to multiple systems and a significant mortality rate (34 per cent). Primary realignment of the urethral injury by a urethral catheter in all cases of urethral rupture (plus a suprapubic cystostomy in most of these cases) resulted in a stricture rate of 62 per cent on follow-up. However, only half of these strictures required surgical correction. The incidence of incontinence was 10 per cent and of impotence 38 per cent.     

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。     

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...     

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.