Flexible cystoscope combined optic internal urethrotomy used in thetreatment of urethral stricture secondary to pelvic frature（Report of 12 cases）
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摘要: 目的:评估膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄的临床疗效。方法:采用膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄男性患者12例,中位年龄33(19~54)岁。术前行尿道探子会师+尿道造影对狭窄部位和长度进行评估,经造瘘口置入膀胱软镜探及尿道内口,经尿道外口置入尿道内切开镜并调暗光源,在膀胱软镜光源引导下行尿道狭窄内切开术,并对手术时间、失血量、并发症进行记录。术后留置尿管1个月,拔除尿管后每月进行随访,术后3个月行尿道造影、尿流率及国际勃起功能指数问卷(IIEF)评分评估。结果:手术均获成功,手术时间(37±12)min,手术后血红蛋白较术前降低(4.5±2.3)g/L,拔除尿管后无尿失禁,术前术后IIEF评分无明显变化(12.4±6.6 vs 13.1±7.0,P>0.05)。随访6~22个月,9例无需进一步处理,排尿正常;3例拔除尿管后出现排尿困难和继发性尿道狭窄,给予每周1次尿道扩张,2例连续4周、1例连续6周尿扩后可置入F18尿道探子,排尿正常,术后3个月Qmax均在(16.2±5.8)ml/s以上。结论:膀胱软镜联合尿道内切开镜会师治疗骨盆骨折术后尿道狭窄简便易行,创伤小,并发症少,近期及远期疗效满意,可作为骨盆骨折术后尿道狭窄的首选治疗方法。Abstract: Objective:To evaluate the clinical treatment efficacy of urethral stricture secondary to pelvic fracture sugery using optic internal urethrotomy guided by flexible cystoscope.Methods:12 patients undergoing suprapubic cystosctomy afer pelvic frature at the median age 33 (ranger from 19 to 54)were retrospectively reviewed by certain criteria. Urethrogram and urethral sounds were used to determine the localtion and length of stricture before sugery. The internal urethrotomy was guided by flexible cystoscope which was inserted from the bladder fistula to the internal urethral orifice. The operation time,blood loss,and complication were recorded. Patients were followed every month after 1 month catheterized.The urethrogram, uroflowmetry, and IIEF was performed in 3 months postoperation.Results:All sugery successed. Operation time was(37±12)min, hemoglobin postoperation decrease was (4.5±2.3)g/L, All patients continence after remove catheter, the IIEF scores change unconspicuously between preopreation and postopreation[(12.4±6.6) vs (13.1±7.0), P>0.05]. The follow-ship last from 6 to 22 months. 9 of 12 satisfied with their urination. Dysuria happened in 3 cases caused by secondary urethrostenosis. 2 patients urinate normally after 4 times and 1 patient for 6 times consecutively urethral dilatations (once a week), finally the F18 urethral sound can be smoothly inserted. Their Qmax were all above (16.2±5.8)ml/s three months later.Conclusions:The optic internal urethrotomy guided by flexible cystoscope is easily to be performed, minimally invasive, few complication. The recently curative effect and longterm outcome is satisfactory. It is optimum option for urethral stricture after pelvic frature.
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Key words:
- urethral stricture /
- pelvic frature /
- flexible cystoscope /
- optic internal urethrotomy
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