Male Urethral Injury And Narrow Clinical Research

BackgroundCurrently urethral stricture disease is relatively common, most strictures being acquired from injury or infection. Blunt perineal trauma causes injury to the bulbar urethra; pelvic fractures result in urethral distraction defects in the posterior urethra, but iatrogenic causes, including urological instrumentation and placing indwelling catheters, which result in strictures anywhere in the urethra, are probably the most common cause. We present 510 cases of male ureathral injuries/strictures who have been treated in West China Hospital between January 1990 and December 2003. Their clinic data were collected and analised with SPSS12. 0. We summarized the management experience in order to offer some reference to clinic physician and deal with such patients more reasonably in the future. Data & MethodBetween January 1991 and December 2003 a total of 510 male urethral strictures were treated with open surgery or endoscopic procedures. A total of 60 cases of pelvic fracture urethral injury were treated with suprapubic tub placement, and 42 with primaryre alignment or primary suturing previously. A total of 473 cases of urethral stricture were treated with surgery or endoscopic procedures, including 245 with direct vision itaemal urethrotomy (DVIE) and 228 with open surgery. Subjectivedata were generally analyzed with SPSS12. 0. ResultsTraffic accident is the most common cause of pelvic fractures, which result in urethral distraction defects in the posterior urethra, andiatrogenic causes, including urological instrumentation and placing indwelling catheters, which result in strictures anywhere in the urethra, are probably the most common cause.. 21 patients relapsed after suprapubic tub placement (35%) and 18 after primaryre alignment or primary suturing previously (42.9). There is no difference of long term effect between different treatments (suprapubic tub placement and primaryre alignment or primary suturing previously.) for pelvic fracuture urethral injury (x 2 = 0. 646, P>0. 05) DVIU is the optimal treatment for those stricture shorter than 2 cm. 184 patients has a less than 2cm long stricture with a higher success rate of 97. 7% than that of the remaining with a more than 2cm long stricture (x2 = 31. 966, P<0.05), For one patient, the effectiveness for more than twice DVIU is very limited. Of the 243 patients single DVIU or twice has the success rates of 86.7% and 83.4% respectively (P>0.05), 21 patients underwent three or more than three times operation with a success rate of 47. 6% which has significant difference with that of the single DVIU or twice procedure. Post-BPH stricture patients treated by TURP has the success rates of 83. 3%and 82.5% of open surgery. The prognosis of post-BPH stricture is not related to the operation method, i. e. open surgery or TURP. ( x "' = 0.012, P>0. 05) End-to-end anastomosis shows a higher success rate, less complications and better long term effects in urethral reconstruction. Pull through operation shows a higher success rate, less complications and better long term effects in urethral reconstruction, which, however, is depend on operator's experiences. Substitution urethroplasty is an essential method for complex urethral stricture, but the long term effect is not satisfied yet.Conclusion1. Pelvic fractures caused by traffic accident result in urethral distraction defects in the posterior urethra, and iatrogenic causes, including urological instrumentation and placing indwelling catheters, which result in strictures anywhere in the urethra, are probably the most common cause.2. The time of indwelling catheter after DVIU is short than open operation.3. The rat of relaps after DVIU is lower than open operation4. Postoperation infection have no correlative relationship with relaspse.5. There is no difference of long term effect between different treatments (suprapubic tub placement and primaryre alignment or primary suturing previously.) for pelvic fracuture urethral injury.6. DVIU is the optimal treatment for those stricture shorter than 2 cm.7. For one patient, the effectiveness for more than twice DVIU is very limited8. The prognosis of post-BPH stricture is not related to the operation method, i.e. open surgery or TURP.9. End-to-end anastomosis shows a higher success rate, less complications and better long term effects in urethral reconstruction.10. Pull through operation shows a higher success rate, less complications and better long term effects in urethral reconstruction, which, however, is depend on operator' s experiences.11. Substitution urethroplasty is an essential method for complex urethral stricture, but the long term effect is not satisfied yet.