Retrospective Analysis Of 122 Cases Of Male Urethral Injury And Stricture

Objective: To summarize the diagnosis and treatment of male urethral injury and stricture,To explore the most effective treatment for male urethral injury and stricture.Methods :The clinical data of 122 patients with urethral injury and stenosis treated in our hospital from 2005 to 2016 were retrospectively analyzed.Results:(1)All of the 122 patients were male,with age range,and the youngest was 4 years old,the oldest was 76 years old,and the average age of the patient was 38 ± 14 years old.The review of statistics shows that:(1)Urethral injury: 120 cases of urethral injury were traumatic,including 13 cases with pelvic fractures.4 cases of other reasons;(2)Urethral stricture: among the 40 patients with urethral stricture,there were 38 cases of stricture after urethral injury.Two cases were narrowed for other reasons.The cause of injury and stenosis was as high as96.7 % and 94.9%.(2)(1)Examination: a total of 12 cases(9.8%,12/122)were reported for urethral imaging.One case of retrograde urethrography of urethral injury was performed.The imaging examination report of urethral stricture had 11 cases.(2)5 cases of urethral membrane stenosis;20 cases of urethral bulb stenosis;1 case of penile body injury;1 case of external urethral injury.The length of injury or stenosis ranges from 0.5cm to 7.0cm,with an average of1.9cm.(3)(1)Treatment of urethral injury: Treatment of 31 patients with indwelling catheter;9 cases chose not to be processed;Suprapubic Cystostomy(SPC)was performed in 73 cases.One patient underwent early ureteroscopy.Four patients were treated with emergency urethral anastomosis.1 case of penile debridement;One case of urethral repair.(2)Treatment of urethral stricture: 28 cases of urethral end anastomosis;The second stage urethroplasty was performed in 6 cases.The second stage urethroplasty was performed in 3cases.Three patients underwent the second stage urethroplasty.1 patient underwent endoscopic surgery(DVIU);1 case of replacement urethroplasty;1routine bladder fistula.(4)Sixty-two patients were followed up by letter return or telephone follow-up,and 28 patients were interviewed with a rate of 45.2%.The follow-up time was 7 to 84 months after surgery.Among the 28 patients in this group,1 patient underwent penile skin replacement urethroplasty,and no urine retention,incontinence,and sexual dysfunction occurred in the patients.In 1 patient,the urethral cavernous body repair was performed,the patient complained of bifurcation,time extension and regular urethral dilatation.One patient underwent the second stage urethroplasty,and the sex life was negatively affected.In 1 case,the patients were treated with direct vision of the urethral incision(DVIU),and the intraoperative exploration of the narrow segment was <2cm.One patient underwent ureteroscopy in the early stage of ureteroscopy,during which the lesion section was <2cm,and the patient had no urinary retention,urinary incontinence and sexual dysfunction after surgery.Two patients underwent the second stage urethroplasty,one patient had no urinary retention,urinary incontinence and sexual dysfunction,and another one died for other reasons.Four patients underwent suprapubic fistula of the pubic bone,one patient died for other reasons,and 3 were selected for long-term replacement of bladder fistula on a long-term basis due to age(average age of64 ± 1.6 years).Six patients were treated with indwelling catheter,and two patients after successful catheterization had the problems of urination,urinary retention and other problems,followed by the urethral end anastomosis.One patient underwent the first stage urethral end anastomosis,accompanied by sexual dysfunction.Of the 10 patients who underwent the second urethral anastomosis,8 of them had no complaints of urinary retention,urinary incontinence and sexual dysfunction,and 2 patients with urinary incontinence and sexual dysfunction.Conclusion:(1)To our hospital patients with urethral injury and narrow showed a trend of decline,the reasons may be related to our country’s economic transformation in the relevant national safety consciousness,is likely to be most of all I division in the urethra injury and narrow paratively insufficient clinical aspects.(2)There were only 12 cases of urethral imaging in122 patients(9.8%,12/122).The diagnosis of urethral stricture is incomplete.In the future,retrograde urethrography should be used as a routine auxiliary examination to improve the accuracy of diagnosis of urethral injury and stricture.(3)In the treatment of urethral injury:(1).The operation of cystectomy is simple,which is the first choice for urethral injury in our hospital.It is suitable for patients who have undergone secondary operation or are willing to make permanent bladder fistula.(2).The incidence of urinary retention,urinary incontinence and sexual dysfunction was high in patients with open urethral surgery.Ureteroscopy under urethral surgery can be used as a diagnostic method,as well as a therapeutic effect,and should be promoted.(3).The successful patients with successful catheterization showed that the urethral injury was relatively mild,and the urethral and erectile function of the patients was not affected.(4)In the treatment of urethral stricture:(1)The second stage urethral end anastomosis has a good effect on the operation,not only the success rate of the operation is higher,but also the complications are less,and the long-term observation is good.(2)The initial treatment of a patient with a narrow ball(<2cm)is the direct vision of the lower urethral incision(DVIU).Two or more DVIU surgeries are of limited value.(3)Urethroplasty is highly dependent on the surgeon’s experience.There is a high level of difficulty for inexperienced doctors.Relative anastomosis has a high incidence of erectile function and urinary incontinence.(4)Substitutional urethroplasty is an important method to treat complex urethral stricture,through graft urethroplasty,the choice of the oral mucosa(skin,tongue,penis mucosa,colonic mucosa),long-term effect is better,to promote learning.