The Discuss On The Selection Of The Male Blunt Urethral Injury Treatment By Goldman Classification

Background: Urethral injury is not rare,in the report,the incidence of urethral injury in pelvic fracture is between 1.6% and 25%,and the incidence is quite different.Urethral injury rates have increased in recent years,the patient is given priority to with 15 to 25 years old,this is probably because young people are more active than older people in a car accident or a traumatic injury to the urethra,such as a heavy load of physical labor.Urethral injury has a tendency to young,inappropriate assessment and treatment will result in serious long-term complications such as urethral stricture,erectile dysfunction,urinary incontinence,urinary fistula,etc.Early treatment of urethral injury has been changed with the development of science and technology,but still not settled yet.At present,there is still debate about the treatment of urethral injury,and the following opinions may affect the choice of treatment modality of urethral injury: First,In the study of the contrast of early endoscopic realignment with cystostomy research due to limited number of cases,preoperative examination is imperfect,the lack of unified standard randomized controlled study,selection bias too big lead to the lack of high quality clinical research;Second,the anatomy of urethral injury iscomplicated,related research has not unified standard of urethral injury classification,such as urethral injury in the part of the urethra injury and completely urethral injury in patients with the same procedure may obtain different results.Goldman anatomy classification,was firstly put forward in 1998 by Goldman and other classification methods,this classification applies to all types of urethral injuries and related clinical symptoms,because this kind of classification method can eliminate the influence by many this kind of classification method is used in the literature suggested in urethral injury,but most for the exchange of experience,there are no clinical data to support.Objective: To observe the distribution of our hospital patients with urethral injury classification of Goldman,discusses classification of Goldman's influence on the different types of operation method choice,and traditional urethral injury classification,the difference between before and after hope to urethral injury has certain guiding significance to the clinical research and clinical treatment.Methods: Case retrieval were retrospectively analyzed by different ways to collect from January 2012-December 2017 for patients with blunt urethral injury admitted to hospital,the collection of data including age,etiology,clinical manifestation,patients with intervention time,after an injury has done all kinds of inspection(including imaging examination,urethral catheterization and anus related body check means such ascheck),after comprehensive analysis,it was traditional urethral injury classification and the classification of Goldman and observed in all points of the two kinds of classification and its type between the urethral catheterization,endoscopic sequential urethroplasty and endoscopic urethra dilatation with indifference.The SPSS 20.0 software was used for statistical processing,and the chi-square test or Fisher's exact probability method was used to determine whether there was a difference between the groups,and P<0.05 was considered statistically significant.Results: 1.In the classification of Goldman,Goldman ? type(40.9%),is the most common,Goldman ? type,Goldman ? type A and Goldman ? type second(27.7%,18.2% and 13.6%,respectively),while in Goldman ? type and Goldman ? type is the most rare.2.In Goldman? type,Goldman ? type,Goldman ? type A,Goldman ? type urethral catheterization success in this type of four points exist difference(P =0.000 < 0.05),and investigate the surgical success rate of early endoscopic realignment and whether need secondary endoscopic sequential urethral dilatation in Goldman ? type,Goldman ? type,Goldman ? there are differences in each of type A type three points respectively(P = 0.01 < 0.05.P = 0.00 < 0.05).3.Before the urethra injury and Goldman ? type in urethral catheterization success rate were50% and 100% respectively,was differences(P = 0.007 < 0.05),the former urethra injury and Goldman ? type in early endoscopicurethroplasty success rate were 71.4% and 16.7% respectively,was differences(P = 0.001 ? 2 = 11.696),posterior urethral injury and Goldman ? type under the early endoscopic urethroplasty was statistically significant,in the comparison of the early endoscopic urethroplasty success rate were 66.7% and 14.3% respectively(P = 0.000,? 2 = 13.170).Before the urethra injury and Goldman ? type A in endoscopic sequential urethral dilatation utilization rate are 25% and 25%respectively,was differences(P = 0.000 < 0.05).Conclusion: Goldman classification than traditional urethral injury classification basically has the following advantages: Goldman classification in urethral injury caused by various reasons has better applicability and can be classified by a variety of tests to determine the Goldman,Goldman classification can estimate the urethral catheterization,investigate the success rate of surgery and postoperative complications of the urethra.Recommend Goldman classification used in the clinical research and practical work,to reduce selection bias and guide the choice of clinical treatment.