尿道假道43例诊治体会

我院自1989年10月～2002年2月共收治外院因尿道狭窄尿道扩张后致医原性尿道损伤(假道)患者43例。现报告如下。     

医源性创伤性后尿道假道形成的诊断和防治

医源性创伤性后尿道假道报道较少。本文报告8例。对其形成原因、发病机制、诊断治疗和预防进行了探讨。     

超声检查在尿道假道诊断中的价值

尿道假道为开口于尿道或膀胱,末端开口于膀胱或末端为盲端的管状结构,盲目粗暴的金属探条尿道扩张是医源性假道产生的主要原因之一,假道形成后如不及时治疗,易在尿道操作时再次损伤及感染。近年来随着腔内操作的日     

改良尿道拖入术治疗外伤性复杂性后尿道狭窄

改良尿道拖入术治疗外伤性后尿道狭窄37例，具有充分切除瘢痕组织、有效预防术后局部感染、术后避免扩张尿道疗效，同时手术操作简单，创伤小，并发症少。     

男童后尿道狭窄的手术径路探讨

目的 探讨男童后尿道狭窄各种手术径路的应用经验，提高男童后尿道狭窄的治疗效果。方法 对22例男童外伤性后尿道狭窄患者的手术径路进行回顾性分析。结果 17例（77.3%）手术治愈。单纯经会阴径路5例，治愈3例；经会阴联合切除耻骨下缘径路8例，治愈7例；经耻骨会阴联合径路9例，治愈7例。结论 男童后尿道狭窄的各种手术径路均存在一定的优缺点，经会阴联合切除耻骨下缘径路具有操作方便、创伤小、并发症少和不破坏骨盆稳定性等优点，尤其适合于男童。     

经尿道内镜操作术后并发尿道狭窄原因分析

目的探讨经尿道内镜操作手术术后并发患者尿道狭窄形成原因及其预防方法。方法对我院2008年7月～2012年9月收治经尿道腔内手术后出现尿道狭窄的48例患者进行回顾性分析。结果术后出现狭窄的时间为1-6个月,平均2．5个月,狭窄部位膀胱颈口处狭窄12例,前列腺部5例,球膜部10例,阴茎体部8例,舟状窝10例,尿道外口3例,后期采取改进措施后狭窄段由原来的（1．5±0．8）cm下降到（0．5±0．6）cm,P〈0．05,。结论尿道狭窄是经尿道手术后常见并发症,采取多环节预防措施能有效预防其发生和减少狭窄程度。     

骨盆骨折致后尿道损伤16例

骨盆骨折所致后尿道损伤，常合并多脏器损伤和休克。早期合理的治疗对减少其远期并发症十分重要。我院于1985～2003年共处理后尿道损伤16例，现报告如下。     

尿道带管造影的临床应用价值

目的 探讨尿道带管造影在尿道狭窄(闭锁)手术后的应用价值.方法 男性尿道狭窄(闭锁)患者62例,年龄18～49岁,平均32岁.其中,44例行尿道端端吻合术,18例行黏膜替代尿道成形术.所有患者术后行尿道带管造影.如造影片提示尿道吻合口愈合良好.则拔除导尿管;如造影片提示尿道吻合口愈合不良,则继续留置导尿管,直到尿道带管造影片提示尿道吻合口愈合良好.结果 93.2%的尿道端端吻合术患者术后2～3周拔除导尿管.88.9%的黏膜替代尿道成形术患者术后2～3周拔除导尿管.尿道端端吻合术的手术成功率为88.6%,黏膜替代尿道成形术的手术成功率为83.3%.结论 尿道带管造影可以准确检测尿道狭窄(闭锁)患者手术后尿道吻合口愈合情况,在术后拔除导尿管时间的选择上有重要的指导意义.     

尿道狭窄超声、造影及手术的对比研究

对40例尿道狭窄患者行B型超声及尿道造影诊断。术中发现,尿道狭窄的长度与B超结果相符(p>0.05)。X线尿道造影5例未显示后尿道,3例出现尿道狭窄假象,与手术结果相比有显著差异(p<0.05)。以20例正常青年男性尿道超声为对照组。球部尿道狭窄经会阴超声探查比经直肠超声容易诊断。与尿道造影相比,超声诊断方法简便迅速,图像清晰,重复性好,医生和患者免受X线损害,并能清楚显示出尿道狭窄周围瘢痕组织的轮廓,有助于选择治疗方式。     

排尿性MR尿道成像对损伤性尿道狭窄的诊断价值

【摘要】目的：探讨排尿性MR尿道成像对损伤性尿道狭窄的诊断价值。方法：对因排尿困难前来本院就诊的73例男性患者进行排尿性MR尿道成像,利用生理盐水或尿液充盈尿道,在患者排尿时进行MR平扫及增强扫描。所有患者均行X线尿道造影及手术治疗。观察尿道狭窄位置、程度、长度、有无瘢痕形成及其周围组织结构关系。对排尿性MR尿道成像、X线尿道造影所测得的尿道狭窄的长度与手术所见尿道狭窄的长度进行统计学分析。结果：57例后尿道狭窄,16例前尿道狭窄;12例尿道完全离断伴有断端错位,38例尿道闭锁无错位,14例尿道重度狭窄,9例尿道中度狭窄;损伤尿道周围均有不同程度瘢痕组织。排尿性MR尿道成像对尿道损伤的定位与X线尿道造影及术中所见结果一致,对尿道周围组织结构的显示与术中所见一致、明显优于X线尿道造影。对于尿道狭窄的长度的判断,MR尿道成像测得的狭窄长度［(1.634±0.6481)cm］与术中测得的狭窄长度［(1.615±0.6843)cm］差异无统计学意义（t=1.242,P=0.2183）,X线尿道造影测得的狭窄长度［(2.100(1.990,2.290)cm］ 与术中测得的狭窄长度差异具有统计学意义(P<0.0001)。结论：排尿性MR尿道成像可以准确显示狭窄尿道及其周围组织结构,指导临床手术方式的选择。     

不同急诊处理方式对前尿道损伤后狭窄发生的影响

目的探讨前尿道损伤后不同急诊处理方式对远期发生尿道狭窄的影响。方法回顾性分析2003年1月—2012年1月前尿道损伤60例的临床和随访资料,根据损伤程度和急诊处理方式分组,比较远期尿道狭窄发生率。结果所有患者平均随访24(18~38)个月,狭窄发生时间为伤后1~13(4.6±2.4)个月。前尿道部分断裂患者38例,其中膀胱造瘘组狭窄发生率12.5%(2/16)低于留置导尿组50.0%(11/22),差异有统计学意义(P<0.05);完全断裂患者22例,其中膀胱造瘘组狭窄发生率66.7%(6/9)与留置导尿组84.6%(11/13)相比无统计学差异(P>0.05)。不考虑损伤程度时,膀胱造瘘组狭窄发生率32.0%(8/25)显著低于留置导尿组62.8%(22/35)(P<0.05)。结论对于前尿道损伤首选膀胱造瘘尿流改道可能减少远期尿道狭窄的发生。     

尿道狭窄或闭锁治疗方法的比较(附96例报告)

目的 评价不同手术方式治疗尿道狭窄或闭锁的临床效果。方法 对近19年来采用不同手术方法治疗的96例尿道狭窄或闭锁病例进行总结。结果 直视下尿道内切开术效果优于会阴开放性尿道手术。结论 在有适应证的情况下,直视下尿道内切开术是治疗尿道狭窄或闭锁较理想的方法。     

男性创伤性复杂性后尿道狭窄的手术治疗

目的 探讨男性创伤性复杂性后尿道狭窄的手术治疗效果.方法 回顾性分析479例诊断为创伤性复杂性后尿道狭窄患者的临床资料.其中422例Ⅰ期行尿道狭窄段切除+端端吻合术,57例行带血管蒂阴囊皮瓣后尿道成形术.结果 手术时间平均115 min(90～140 min),术中平均出血量225 ml(100～300 ml).无一例需术中输血.术后平均随访15个月(12 ～24个月),422例行尿道吻合术的患者中,386例排尿通畅,36例排尿不畅的患者中,再次行排泄性尿道造影提示21例是因为吻合口瓣膜形成,15例因局部存在狭窄环,行尿道瓣膜切除或狭窄环内切开术,术后恢复良好.57例行后尿道成形术患者中,45例排尿通畅;9例患者出现前尿道与皮管吻合口狭窄,其中4例行尿道扩张后好转,5例行尿道狭窄内切开术后好转;3例出现皮管与后尿道或膀胱颈吻合口狭窄,其中1例经尿道扩张后好转,2例行尿道狭窄内切开术后好转.结论 Ⅰ期尿道狭窄段切除+端端吻合术是治疗创伤性复杂性后尿道狭窄的主要方法,病情不允许时可行后尿道成形术.     

Comparison of radiographic and sonographic urethrography for assessing urethral strictures

The aim of this study was to compare radiourethrography (RUG) and sonourethrography (SUG) for assessment of urethral strictures and to evaluate whether RUG underestimates stricture length, as has been reported. Fifty-one men with suspected urethral strictures were evaluated by both methods performed consecutively. Stricture lengths and diameters measured by RUG were significantly greater (mean 22%, 30%) than those measured by SUG because of radiographic magnification. Both methods, however, detected a similar percentage lumen reduction and similarly graded stricture severity. Equally significant non-correlation between both methods for length measurements in the bulbar and penile urethra (p<0.001, R²=0.33 and 0.34, respectively) supported radiographic magnification. Previous inaccuracies appear to relate to RUG measurements of the central tight stricture (mean 44% of the entire length in our series), not the full stricture length. Use of sonographic contrast medium intra-urethrally improved the definition of long narrow strictures. The SUG gave information about peri-urethral tissues not provided by RUG. Once radiographic magnification was taken into account, there were no major differences in the assessment of urethral strictures by both methods. With correct measurement methods, RUG does not underestimate stricture length. For full assessment, the combination of RUG and SUG, which gives information about peri-urethral disease, is optimal in many patients.     

A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures

AIM: This prospective study was undertaken to evaluate the abnormalities of the male anterior urethra using high-resolution ultrasound (sonourethrography) and to compare the efficacy with that of retrograde urethrography (RGU) using operative findings as the gold standard. MATERIALS AND METHODS: Seventy patients with symptoms of lower urinary tract obstruction underwent RGU followed by sonourethrography. The sonologist was blinded to the findings of RGU. The parameters studied were compared with the intra-operative findings as gold standard, and the sensitivity, specificity and overall accuracy for the procedures were calculated. Chi-square test and kappa statistics were used where appropriate. RESULTS: All patients found to have urethral stricture disease by RGU were also detected by sonourethrography and confirmed intra-operatively. In the estimation of stricture length, RGU showed a lower sensitivity (60-80%) for lengths 1-4 cm, compared with sonourethrography (73.3-100%). Spongiofibrosis was detected by sonourethrography with a sensitivity of 77.3-83.3%. All the false tracts and calculi detected at sonourethrography were confirmed at surgery, whereas RGU showed a low sensitivity in their detection. The complications encountered during the procedures were pain, urethral bleeding and contrast intravasation. The frequency of pain during RGU was greater (p < 0.001); however, the difference in frequency of bleeding after the two procedures was not significant (p < 0.5). CONCLUSION: RGU and sonourethrography are equally efficacious in detection of anterior urethral strictures. Further characterization of strictures in terms of length, diameter and periurethral pathologies, like spongiofibrosis and false tracts, is done with greater sensitivity using sonourethrography as compared with RGU, with the added benefit of lower incidence of complications.     

经耻骨径路治疗骨盆骨折后复杂性后尿道狭窄

目的 探讨经耻骨径路治疗骨盆骨折后复杂性后尿道狭窄的手术安全性和长期疗效.方法采用经耻骨径路治疗复杂性后尿道狭窄26例,其中男21例,女5例;年龄16～65岁,平均26岁.后尿道狭窄长度2.5～4.0 cm 23例,>4.0 cm 3例,其中尿道闭锁5例.尿道断端彻底切除瘢痕后采用端端吻合术,观察手术效果及术中术后并发症.结果 随访1～7年,平均4年.22例(85%)手术成功,排尿通畅.无耻骨炎、骨盆分离、骨盆不稳定、尿失禁等并发症.1例(4%)排尿不畅,3例(11%)失败.结论经耻骨径路治疗骨盆骨折后复杂性后尿道狭窄安全可行,切除尿道瘢痕彻底,无严重并发症,长期疗效良好,值得临床选择性使用.     

半导体激光治疗后尿道狭窄的临床经验

为观察半导体激光治疗后尿道狭窄的效果，１９９５年１０月～１９９７年３月，应用ＤＩＯＭＥＤ半导体激光器治疗后尿道狭窄１６例，１３例获得手术一次成功，其余３例首次手术无改善，是尿道内瓣膜所致。结果表明，此种激光治疗后尿道狭窄成功率高，但尿道内残余瓣膜是手术失败的主要原因。半导体激光器较之其他类型激光器有功率大、汽化效果好、操作简单等优点。     

直视下尿道内切开术后再次狭窄20例分析

目的对直视下尿道内切开术(DVIU)的术后疗效进行分析,重新认识DVIU的手术适应证,探索降低DVIU术后再次狭窄的方法。方法回顾性分析2004年1月至2009年4月78例尿道狭窄行DVIU术临床资料,对DVIU术后再次尿道狭窄病例进行分析,术前狭窄长度≤1.0㎝15例,1.1～2㎝42例2,～2.5㎝15例,≥2.5㎝6例,狭窄部位后尿道42例、前尿道36例,尿道球部2例。结果 DVIU1次成功70例,2次成功8例,术中加用电切12例,术后留置尿管时间3天～3月。术后随访1年,再次发生尿道狭窄20例,其中术后3月9例,术后半年11例。结论选择≤1㎝的尿道狭窄作为手术适应证,术中轻柔操作,合理选择留置尿管时间等,能降低DVIU术后再次尿道狭窄的复发率,应当有选择性地应用DVIU。     

Contrast ultrasound of the urethra in children

The aim of this study was to report our experience with transperineal ultrasound in studying the urethra, as a complementary technique to contrast-enhanced voiding urosonography (VUS). The VUS was performed in 350 patients (244 males, 106 females) less than 4 years of age, and complemented with perineal US. Ultrasound of the kidneys and bladder was obtained before and during bladder filling and post-voiding. The urethra and the neck of the bladder were evaluated sagittally by transperineal ultrasound (5–7.5 MHz) before, during, and after voiding. Only cases of posterior urethral valves diagnosed at VUS were followed by voiding cystourethrography (VCUG), which was performed on a different day. A satisfactory evaluation of the urethra was obtained in 332 cases (94.86%): (a) normal urethra (n=328); and (b) posterior urethral valves (n=4). In the latter 4 cases there was concordance between results at VUS and VCUG. Eighteen cases (5.14%) were excluded from the study because the quality of the examination was suboptimal. Transperineal US offers an initial imaging modality for studying urethral pathology and thus may complement VUS. This paper was presented at the IPR meeting 2001, in Paris.