Surgical Treatment of 31 Complex Traumatic Posterior Urethral Strictures Associated with Urethrorectal Fistulas

Background

Urethrorectal fistulas (URF) in patients with complex posterior urethral strictures are rare and difficult to repair surgically. There is no widely accepted standard approach described in the published literature.

Objective

The aim of this study was to describe the outcomes of various operative approaches for the repair of URFs in patients with complex posterior urethral strictures.

Design, setting, and participants

From January 1985 to December 2007, 31 patients (age: 6–61 yr; mean: 28.4) with URFs secondary to posterior urethral strictures were treated using a perineal or combined abdominal transpubic–perineal approach.

Interventions

A simple perineal approach was used in 4 patients; a transperineal inferior pubectomy approach was used in 18 patients; and a combined transpubic–perineal approach was used in 9 patients. A bulbospongiosus muscle and subcutaneous dartos pedicle flaps were interposed between the repaired rectum and urethra in 22 patients. The combined transpubic–perineal approach used either a gracilis muscle flap (one patient) or a rectus muscle flap (eight patients).

Measurements

Suprapubic catheterisation was used for bladder drainage, and a urethral silicone stent was left indwelling for 4 wk.

Results and limitations

One-stage repair was successful in 4 patients (100%) using the perineal approach, in 16 of 18 patients (88.9%) using the transperineal–inferior pubectomy approach, and in 7 of 9 patients (77.8%) using the transpubic–perineal approach. Recurrent urethral strictures developed in two cases; one patient required regular dilation, and the other patient was treated successfully with tubed perineoscrotal flap urethroplasty. Recurrent URFs developed in two additional patients.

Conclusions

Surgical approaches for the treatment of URFs associated with complex urethral strictures should be based on a number of considerations including the location of the URF, its aetiology, the length of the urethral strictures, and a history of previous unsuccessful repairs. These results demonstrate that the transperineal–inferior pubic approach may be appropriate as a first-line procedure.     

微创腔内技术在输尿管新膀胱吻合口狭窄治疗中的应用

目的:探讨微创腔内技术在输尿管新膀胱吻合口狭窄中的临床应用价值。方法:对13例行膀胱全切术后出现不同程度输尿管新膀胱吻合口狭窄的患者,利用微创腔内技术行输尿管狭窄切开术,术后用影像学检查进行随访,了解输尿管新膀胱吻合口再次发生狭窄机会及分肾功能的变化。结果:13例患者治疗均获成功。患者拔除输尿管支架管后3个月行影像学复...     

经胃粘膜下层食管胃粘膜单层吻合的临床研究

目的：探讨预防食管胃吻合术吻合口瘘、吻合口狭窄以及反流性食管炎的手术方法。方法：按根治要求切除恶性肿瘤，关闭残胃断端，在保留胃的前壁分别置作3cm宽的隧道出、入口，出、入口间距为3cm，经胃粘膜下层打通出、入口，构成胃壁“隧道”。游离食管粘膜3cm，由隧道入口至出口，距出口远端胃浆肌层断缘0．5cm处，横行切开胃粘膜3cm作为吻合口，行食管胃粘膜单层吻合，关闭出、入口，置游离的食管粘膜于隧道内。结果：本组300例术后无1例早期死亡和发生吻合口瘘，吻合口狭窄和反流性食管炎各2例。结论：经胃粘膜下层食管胃粘膜单层吻合可以预防吻合口瘘、吻合口狭窄和反流性食管炎。     

纤维胆道镜治疗肝内结石并胆管狭窄178例

目的介绍纤维胆道镜治疗肝内结石并肝胆管狭窄的经验。方法回顾性分析我院自1998年至2008年利用纤维胆道镜诊治的178例肝内结石并胆管狭窄患者的临床资料。结果在178例肝内结石并狭窄病例中，176例结石被取净，2例失败，结石取净率为98％；全组无死亡病例。结论纤维胆道镜在治疗肝内结石并胆管狭窄中具有重要作用，不仅能降低结石残留率，而且还具有安全性高、费用低、创伤小等优点。     

Prevalence of Complicated Gastroesophageal Reflux Disease and Barrett’s Esophagus Among Racial Groups in a Multi-Center Consortium

Aims The Clinical Outcomes Research Initiative database was used to evaluate ethnic trends in complicated reflux disease and suspected Barrett’s esophagus among various racial groups. Methods Endoscopic findings for procedures performed January 2000–December 2005 for any indication and for reflux-related indications were reviewed by racial group. Results Of 280,075 procedures examined, Hispanics were the most likely to have esophagitis (Hispanic 19.6%, white 17.3%, black 15.8%, Asian/Pacific Islander 9.5%, P-value < 0.0001), and white subjects were most likely to have suspected BE (white 5.0%, Hispanic 2.9%, Asian/Pacific Islander 1.8%, black 1.5%, P-value < 0.0001). Endoscopies performed for reflux-related indications had similar trends for esophagitis and esophageal stricture. Among reflux/Barrett’s screening procedures adjusted for age and gender, Hispanics were most likely to have esophagitis (OR = 1.28, P-value < 0.0001) compared to Caucasians. Conclusion Our results demonstrate an association of suspected Barrett’s esophagus and stricture with white patients and esophagitis with Hispanic patients. These findings need to be followed-up with further study.     

离断性肾盂成形术双J管内引流治疗肾盂输尿管连接部狭窄

目的:探讨离断性肾盂成形术双J管内引流治疗肾盂输尿管连接部狭窄的临床疗效.方法:采用离断性肾盂成形术治疗先天性肾盂输尿管连接部狭窄32例共35侧,常规采用双J管作支架内引流,术后1个月拔除双J管,3个月行静脉肾盂造影复查.结果:患肾积水好转,吻合口通畅,尿常规检查无严重尿路感染.结论:离断性肾盂成形术是治疗肾盂输尿管连接部狭窄的有效方法,术中使用双J管能减少术后再狭窄的发生,提高手术的成功率.