尿道与膀胱颈或膀胱前壁吻合术治疗骨盆骨折后难治性后尿道狭窄——6例报告

URETHRO-BLADDER NECK OR URETHRO-ANTERIOR BLADDER WALL ANASTOMOSIS FOR POSTERIOR URETHRAL STRICTURES DUE TO PELVIC FRACTURE

作者对6例骨盆骨折所致后尿道狭窄(长3~5cm,均曾多次手术失败)施行了尿道膀胱颈吻合术(4例)或尿道膀胱前壁吻合术(2例)。手术采用经会阴部切口,切开尿生殖膈,切除疤痕组织并使形成隧道。将尿道游离后直接与膀胱颈吻合,或将尿道向前移位与膀胱前壁切口吻合。经1~4年随访,均排尿良好。1例术后仍有阳萎,3例能勃起但无排精。

Since 1978,we have performed direct urethrovesical anastomosis in 6 cases of posterior urethral stricture caused by pelvic fracture.All had been previously operated upon with failure.The strictured segment measured 3-5 cm.Urethrobladder neck anastomosis was done in 4 cases and urethro-anterior bladder wall anastomosis in 2 cases.The intracrural septum was incised and a tunnel was made behind the pubic bone by removal of scar tissue.Through the tunnel the mobilized anterior urethra was passed and then anastomosed to the bladder neck or anterior wall.All the patients had good micturition in the follow-up period of 11/4-4 yrs.One patient had preoperative impotence not improved and 3 were potent but could not ejaculate.The indications and merits of the operation are discussed.