| Male pelvic fracture urethral injuries and urethral strictures are the oldest known urological disease and remain a commom problem with high complication and morbidity. If not managed properly it may lead to a lifelong condition with deleterious consequences comprising not only the ability to void and maintain urinary continence, but also the ability to reproduce and survive. For many years endoscopic technique to treat urethral strictures have being rapidly developed. However, people found the longer the followup, the higher the failure rates, even after repeat urothrotomy the recurrence rate remains high. We present 349 cases of male pelvic fracture urethral injuries or/and urethral strictures who have been treated with surgery or endoscopic procedures in the first affiliated hospital of medical college of Zhejiang university between January 1997and December 2002. We followed up them after the treatment and analyze their questionnaires. We summarized the successful experience in order to offer some reference to clinic physicians and deal with such patients more reasonably in the future.CLINIC DATA & METHODBetween January 1997 and December 2002 a total of 349 male pelvic fracture urethral injuries or/and urethral strictures were treated with open surgery or endoscopic procedures. A total of 236 cases of pelvic fracture urethral injury were treated with suprapubic tub placement, primary realignment or primary suturing previously. A total of 308 cases of urethral stricture were treated with surgery or endoscopic procedures, including 217 with direct vision internal urethrotomy (DVIU) and 91 with anastomotic urethroplasty or substitution urethroplasty. Mailed questionnaires or a telephone interview, if questionnaires were not returned, provided information on the history, urinary, voiding, sexual function, overall satisfaction and et al. after treatment. Subjective data were generally analyzed.RESULTSThere are 317 patients followed up completely and 32 patients lost. Of the 3 conventional treatment methods to the pelvic fracture urethral injuries primary suturing of the urethral ends has the greatest complication rates of impotence (58.5%, P<0.01) and incontinence (23.5%, P<0.05). Primary realignment has the similar incidence of impotence and incontinence to the suprapubic tub placement. Of the 217 patients internal urethrotomy has been successful in 175 (80.6%), 159 patients has a less than 2cm long stricture with a higher success rate of 88.0% than that of the remaining with a more than 2cm long stricture (P<0. 01). Of the 217 patients single DVIU or twice has the success rates of 63.6% and 48.5% respectively (P>0.05), 23 patients underwent three or more than three times operation with a success rate of 17.4% which has significant difference with that of the single or twice procedure (P<0. 01). Of the 91 open surgical revisions, 45 patients underwent anastomotic urethroplasty with a success rate of 86.7% after average of 32.7 months of followup, 46 patients treated with substitution urethroplasty have an average success rate of 63.0% with a trend of decreasing with time.CONCLUSION1. Of the 3 conventional treatment methods to the pelvic fracture urethral injuries primary suturing has the greatest complication rates of impotence and incontinence. The Primary realignment and suprapubic tub placement had nearly equal low incidence of impotence and incontinence.2. DVIU is a safe and efficient treatment for male urethral stricture disease. It should be considered the treatment of first choice for the urethral stricture with less than 2cm long. More than twice operation is of limited value.3. Anastomotic urethroplasty for anterior stricture has a high success rate of 86.7%. It is technically straightforward and complications are uncommon.4. As a method for the complicated urethral strictures, substitution urethroplasty is a candidate.
|
PDF Full Text Request