背景:男性尿道断裂损伤是泌尿外科急症。原发性内窥镜重新对准(PER)是指通过膀胱镜留置尿道导管重建尿道对准,建议将其作为减少损伤后并发症可能性的最佳紧急治疗方法。然而,现有文献表明,由于复杂的尿道中断,PER的成功率相对较低.我们报告了一种改良的PER方法,该方法可提高治疗的成功率和安全性。
方法:一名19岁男性患者在高速交通事故后出现多处骨盆骨折和完全尿道中断。患者的腹部计算机断层扫描和逆行尿道造影结果显示球尿道完全中断,血肿和造影剂外渗延伸到腹膜外空间。由于严重的破裂和大量的血肿,通过膀胱镜进行的常规逆行PER失败。改良的同时顺行和逆行PER是通过半刚性输尿管镜检查通过耻骨上Foley导管和膀胱镜检查通过外部尿道进行的。顺行导丝穿过膀胱颈,然后用膀胱镜拉出尿道外道。将16-Fr硅胶Foley导管沿着导丝浸入膀胱后,实现了尿道连续性。病人恢复得很好,实现排尿节制,避免尿道狭窄进一步手术。
结论:经耻骨上Foley导管改良PER是后尿道损伤患者一种有希望且安全的治疗方法。
BACKGROUND: A male urethral disruption injury is a urological emergency. Primary endoscopic realignment (PER) refers to reestablishment of urethral alignment via indwelling urethral catheter by cystoscope, which is recommended as the optimal emergent treatment approach for reducing the likelihood of complications following injury. However, the prior literature suggests the success rate of PER to be relatively low due to complicated urethral disruption. We report a modified PER approach that serves to improve both the success rate and safety of the treatment.
METHODS: A 19-year-old male patient presented with multiple pelvic fractures and complete urethral disruption following a high-velocity traffic accident. The patient\'s abdominal computed tomography and retrograde urethrography results revealed complete urethral disruption at the bulbar urethra, with hematoma and contrast medium extravasation that extended into the extraperitoneal space. The conventional retrograde PER by cystoscope failed due to severe disruption and considerable hematoma. Modified simultaneous antegrade and retrograde PER was performed by means of semi-rigid ureteroscopy via a suprapubic Foley catheter and cystoscopy via the external urethra. An antegrade guidewire was passed through the bladder neck and then pulled out through the external urethral meatus with a cystoscope. Urethral continuity was achieved after a 16-Fr silicone Foley catheter was indwelled into the bladder along the guidewire. The patient recovered well, achieving voiding continence and avoiding further operation for urethral stricture.
CONCLUSIONS: Modified PER via suprapubic Foley catheter represents a promising and safe treatment approach in patients with posterior urethral injuries.