双输尿管镜联合肾穿刺针治疗成年男性尿道闭锁

目的探讨双输尿管镜联合肾穿刺针治疗成年男性尿道闭锁的临床疗效。方法11例成年男性后尿道闭锁采用双输尿管镜联合肾穿刺针治疗。患者尿道闭锁段均位于尿道膜部和威球部，闭锁长度0．5—1．5cm，中位数1．1cm，无骨片压迫尿道。手术关键点为从尿道及膀胱造瘘口各置入输尿管镜观察闭锁段远近端，在双输尿管镜监视下，用肾穿刺针从闭锁段远端穿刺至闭锁段近端以确定正道，而后用尿扩及电切修整尿道。观察手术的疗效。结果11例全部手术成功，术后仅有少量尿道出血，留置尿管压迫后均止血。拔除尿管后均排尿顺畅，4例一度尿线变细，门诊尿道扩张后排尿通畅。术后无尿道热等近期并发症及尿失禁等远期并发症。结论双输尿管镜联合肾穿刺针治疗成年男性尿道闭锁成功率高，疗效好，并发症少。

The clinical effect of the operation with double ureteroscopes and renal puncture needle for atresia of urethra

Objective To evaluate the therapeutic efficiency of the operation with double ureteroscopes and renal puncture needle for atresia of urethra. Methods Eleven adult male patients with atresia of urethra underwent the operation with double ureteroscopes and renal puncture needle. The atresia length ranged from 0.5 to 1.5 cm. No fragment of bone compressed the urethra. The key point of surgery was that a renal puncture needle was punctured from distal-end to proximal-end under the observation of 2 ureteroscopes （one was observing the proximal-end of atresia through bladder fistula and the other was observing the distalend through urethral orifice） to determine the right lumen of atresia of urethra. After that, dilation of urethra and transurethral resection were followed. Results The operations with double ureteroscopes and renal puncture needle for all patients with atresia of urethra were sucessful. Little bleeding happened which were relieved with the placement of catheter. All patients got satisfactory voiding. Stricture recurred in 4 patients whose symptoms disappeared after urethral dilation. No severe complication occurred （for example, urinary incontinence）. Conclusions The operation with double ureteroscopes and renal puncture needle for atresia of urethra is effective, with high cure rate and few complications.