男性骨盆骨折致后尿道损伤的治疗研究进展

泌尿生殖器损伤是骨盆骨折的严重并发症之一,患者常常合并严重多发伤,病情严重、复杂,临床医师在早期救治时往往顾此失彼。尿道损伤的长度、部位、严重程度与骨盆骨折的类型有关。目前关于骨盆骨折致后尿道损伤(PFUI)的早期处理、合并症的治疗方式尚无统一方案。近年来国内外学者对此进行了大量的研究,并且某些研究已取得良好的治疗效果。本文对男性PFUI的治疗作一综述。     

骨盆骨折尿道损伤后阴茎勃起功能障碍的诊治体会

骨盆骨折尿道损伤病人阴茎勃起功能障碍(erectiledysfunction ,ED )的发生率高达 5 4%～6 2 % [1] 。我院男性专科门诊自 2 0 0 1年 6月～ 2 0 0 2年 9月共诊治 2 3例 ,报告如下。1　临床资料1.1　一般资料　 2 3例病人 ,年龄 2 3～ 4 0岁 ,平均 31岁 ,均已婚。所有病人损伤前阴茎勃起功能正常 ,在损伤后或手术后出现ED。骨盆骨折类型 :耻骨双骨折伴坐骨骨折 13例 ,单侧耻骨骨折或伴坐骨骨折 10例。尿道损伤类型 :部分断裂 6例 ,完全断裂 17例。当时处理情况 :在行骨盆骨折手术后 ,14例仅行膀胱造瘘术 ,9例急诊行尿道吻合术。1.2　检查方…     

骨盆骨折合并后尿道损伤致阴茎勃起功能障碍48例临床分析

目的探讨男性骨盆骨折合并后尿道损伤致阴茎勃起功能障碍（ED）的诊治经验。方法回顾性分析48例男性骨盆骨折合并后尿道损伤患者的临床资料,其中28例急诊行尿道端端吻合术,13例患者Ⅰ期先行膀胱造瘘术,3～6个月后行尿道瘢痕切除＋Ⅱ期尿道吻合术或冷刀切开术,5例行尿道会师牵引固定术,2例行保守治疗后仅留置导尿管。其中15例不稳定型骨盆骨折并发后尿道断裂伤的患者同期行骨盆复位内固定术。结果 48例患者中39例出现不同程度勃起功能障碍,术后通过病史、查体、实验室检查,国际勃起功能指数、夜间阴茎勃起（NPT）监测,罂粟碱试验、彩色多普勒血流显像（CDU）、动态阴茎海绵体造影、球海绵体肌反射（BCR）和尿动力学检查等方法。其中神经性勃起障碍28例,动脉性15例,静脉性4例,心理性2例。结论 ED是骨盆骨折合并后尿道损伤的常见并发症,严重骨盆骨折致后尿道的损伤发生ED的机率明显升高。     

骨盆骨折后尿道损伤及后尿道狭窄

骨盆骨折合并后尿道损伤的发病率近年来呈上升趋势 ,对后尿道损伤的诊断与处理日益重要 ,处理不当日后需再次手术 ,引起尿失禁、阳瘘则留下终身残废。作者就骨盆骨折后尿道损伤及后尿道狭窄的发病率、尿道损伤机制、后尿道损伤分类、诊断和处理作综述。     

男性骨盆骨折后尿道损伤早期处理方式的历史演变

男性骨盆骨折后尿道损伤(PFUI)是泌尿外科修复重建领域棘手的问题之一,其早期处理目前尚有争议。本文将结合欧洲泌尿外科协会指南及相关文献对PFUI早期处理方式的历史演变进行梳理。     

骨盆骨折合并尿道损伤的处理

目的 探讨骨盆骨折合并后尿道损伤的治疗方法和疗效.方法 自2004年1月～2009年6月收治骨盆骨折合并后尿道损伤36例,尿道撕裂伤23例,断裂伤13例.骨盆骨折采用下肢牵引治疗9例,单纯骨盆前环外固定架固定13例,重建钢板内固定9例,骨盆前环内、外固定架+骨盆后环内固定5例.结果 36例均获得随访,随访时间10个月～4.5年.骨折愈合率为100%,继发骨盆畸形7例,25例拔除尿管后不能自行排尿,需行尿道扩张术.2例男性患者出现性功能不全,无一例发生尿失禁.结论 骨盆骨折合并后尿道损伤恢复并维持有效的血液动力学指标后,应尽早修复损伤尿道,能提高救治成功率;通过骨盆环复位固定,减小尿道吻合处及周围组织张力,提高尿道损伤修复术后通畅率.     

骨盆骨折合并后尿道损伤的诊疗进展

后尿遭损伤常并发于骨盆骨折。前列腺膜部尿道断裂,几乎全部见于骨盆骨折病人(5～15.5％)。由于交通事故日趋增多,此类病人显著增加,引起了泌尿外科及骨科医师的关注。以往的处理多偏重于恢复尿道的连续,而对骨盆骨折的治疗常不够重视,多采用保守治疗或仅作牵引与外     

骨盆骨折引起后尿道损伤的早期处理

目的：探讨骨盆骨折引起后尿道损伤早期合理的处理方法。方法：回顾性分析36例男性骨盆骨折并发后尿道损伤患者的临床资料,其中8例尿道黏膜裂伤或尿道部分断裂患者行留置导尿,另28例尿道完全断裂患者均在伤后24h内行手术治疗,其中18例行尿道会师加牵引,其余10例单纯膀胱造瘘。结果：随访6个月～5年,8例留置尿管患者,拔管后排尿通畅6例,尿线变细2例,经定期尿道扩张,排尿正常。18例尿道会师加牵引患者,拔管后适时扩张尿道,排尿通畅15例,尿线较细3例,经定期尿道扩张后,1例排尿通畅,2例失败。10例单纯膀胱造瘘患者,术后均不能排尿,分别于伤后6～12个月行开放手术及尿道内切开治疗。结论：尿道会师加牵引术是治疗骨盆骨折所致后尿道断裂的有效方法。     

骨盆骨折合并后尿道损伤后阳萎发生机理的临床研究

为探讨骨盆骨折后尿道损伤后发生阳萎的机理、收集５１例骨盆骨折、后尿道损伤后患者的资料，对其性功能状况进行随访，并对１０例阳萎患者进行了有关阴茎勃起功能的检查。结果表明：伤后阳萎是初期损伤和（或）手术损伤所造成的阴茎神经、动脉损伤所致。由于解剖上的原因，单纯早期损伤所致阳萎多为神经性阳萎，而手术损伤多为动脉性阳萎。此外，损伤程度、伤时年龄及伤后时间等因素与阳萎的发病也有一定的关系。     

骨盆骨折并后尿道损伤致阴茎勃起功能障碍28例临床分析

目的探讨骨盆骨折并后尿道损伤致阴茎勃起功能障碍（ED）的类型、发病机制和治疗方法。方法通过病史、查体、实验室检查，国际勃起功能指数，NPT、罂粟碱试验、阴茎Doppler声、动态阴茎海绵体造影、球海绵体肌反射和尿动力学检查等方法，对骨盆骨折并后尿道损伤引起的阴茎勃起功能障碍28例患者进行诊断、分类，对不同类型的ED患者进行相应治疗。站果ED28例，其中神经血管性ED22例，血管性ED6例。22例神经血管性ED化学假体治疗，22例注药后阴茎勃起完成性交。其中5例治疗半年后阴茎勃起功能逐渐恢复；17例未能坚持治疗，12例改服万艾克，5例服药后完成性交。4例血管性ED行腹壁下动脉与阴茎背深静脉吻合术，术后能完成性交。结论ED是骨盆骨折并后尿道损伤的常见并发症。神经血管损伤是ED的主要原因，化学假体和口服万艾克有一定疗效。血管性ED手术治疗有一定疗效。     

骨盆骨折后尿道损伤和阳萎

目的：探讨骨盆骨折后尿道并发阳萎的机制及如何避免阳萎的发生。方法：随访骨盆的后尿道损伤１８例与狭窄２５例的治疗效果。结果：后尿道损伤１８例,采用会师牵引复位术治疗,２例发生阳萎（１１．１％）;陈旧性后尿道狭窄２５例,经各种手术修复尿道后,５例发生阳萎（２０．０％）。结论：阳萎主要由骨盆骨折损伤勃起神经与血管及阴茎海绵体引起,伤后的手术操作及多次尿道复位或成形术,亦增加阳萎的发生率。     

Penile injury and effect on male sexual function

Penile injury is common as an emergency and should be accurately diagnosed and treated. We analysed 22 patients with penile injury admitted to the emergency unit of Dubrava University Hospital during a 4-year period. According to the American Association for the Surgery of Trauma five-grade classification of penile injuries, there were 14 grade I, 6 grade II and 2 grade III cases. Diagnosis was mainly based on clinical and ultrasonography findings, and in some cases on cavernosography. Nineteen patients underwent immediate surgery and three patients received conservative therapy. On outpatient follow up, sexual function was assessed by use of the 5-item International Index of Erectile Function (IIEF-5) test at 3 and 12 months of injury. At 3-month follow up, moderate, mild and no erectile dysfunction was recorded in 5, 6 and 11 patients respectively (mean IIEF-5: 19.62). At 12-month follow up, mild erectile dysfunction was found in only one patient (IIEF-5: 20), whereas all other patients were free from erectile dysfunction (mean IIEF-5: 23.75). The 12-month follow up yielded a higher statistical difference (P < 0.001) when compared with 3-month follow up. Study results indicated that appropriate treatment of penile injuries resulted in complete recovery of sexual function within 12 months.     

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。     

Effect of daily sildenafil on patients with absent nocturnal erections due to pelvic fracture urethral disruption: a single‐centre experience

Erectile dysfunction (ED) is a common sequel of pelvic fracture urethral disruption. Those patients with nocturnal erections may respond favourably to sildenafil; however, little is known about the response to sildenafil in patients with absent nocturnal erections. The aim was to evaluate the response to the treatment of sildenafil 50 mg taken once daily in the patients with absent nocturnal erections. From January 2008 to December 2011, a total of 28 patients with absent nocturnal erections were evaluated. We recorded nocturnal penile tumescence and rigidity with an erectometer. If nocturnal erections were absent for three nights, patients were administrated sildenafil 100 mg at bedtime and tested again at the fourth night. Penile duplex ultrasound with intracavernous injection was performed to define the cause of ED. All patients received a daily dose of sildenafil 50 mg for 12 weeks. Response to sildenafil treatment was defined as sustained erections allowing vaginal penetration and intercourse. Twenty‐three (78%) patients completed the daily sildenafil treatment, and follow‐up was available. The nocturnal erections at the fourth night in 13 patients (46.4%) were improved. About 61.5% (8/13) reported effective response to daily sildenafil. The improvement of nocturnal erections induced by sildenafil taken at bedtime might predict the response to sildenafil taken daily.     

Posterior pelvic ring injury of straddle fractures: Incidence,fixation methods,and clinical outcomes

Straddle fracture, a superior and inferior ramus fracture of both sides, is generally treated conservatively. However, posterior pelvic ring injury is often associated with straddle fracture, leading to unstable pelvic bone fracture that requires surgical treatment. The present study reports the clinical and radiological outcomes of straddle fracture with posterior pelvic ring injury.This study included 73 patients (41 men, 32 women) with a straddle fracture injury. The injury mechanism, injury severity score (ISS), accompanying injuries, presence of posterior pelvic ring injury, and fixation methods for the pelvic fracture were analyzed, and outcomes were evaluated functionally and radiologically.Of the 73 patients, 56 (77%) had a posterior pelvic ring injury and 7 died. In 43 patients, the posterior pelvic ring injuries constituted unstable pelvic injury and were treated surgically. The fixation method was determined based on the severity of the posterior pelvic injury. The patients’ mean ISS was 24.7 points. Radiological evaluation of surgical outcomes in 43 patients revealed the outcomes as anatomic in 20, nearly anatomic in 14, moderate in 5, and poor in 4, whereas functional evaluation revealed the outcomes as excellent in 21, good in 9, fair in 7, and poor in 6.Posterior pelvic ring fracture can accompany straddle fractures, which may lead to pelvic injury instability. Thus, special attention is required for patients with a straddle fracture.     

骨盆骨折尿道损伤的早期处理

骨盆骨折尿道损伤是泌尿外科最为棘手的难题之一,严重影响患者的生活质量。骨盆骨折尿道损伤的早期诊断和及时正确的处理至关重要。逆行尿道造影不仅可以了解有无尿道损伤,还可以明确尿道损伤的类型,是目前推荐使用的诊断方式。骨盆骨折尿道损伤早期处理方式较多,目前耻骨上膀胱造瘘术、二期尿道修复术是首选治疗方式。本文就骨盆骨折尿道损伤的早期处理方式及要点综述如下。