Contrast Study On The Efficacy And Safety Of Urethral Anastomosis And Holmium Laser Incision For Pelvic Fracture Urethral Distraction Defect

Objective:To compare the efficacy and safety of open urethral anastomosis and transurethral holmium laser incision for the treatment of PFUDD,and to provide a reference for the choice of surgical methods.Methods:The study selected 112 male PFUDD patients admitted to the China–Japan Union Hospital of JILIN University from May 2013 to August 2017.The urethral stricture or atresia was confirmed by urography,urodynamics and other auxiliary examinations,and patients with diseases such as neurogenic bladder and urethral tumor were excluded.The age ranged from 20 to 72 years,with an average of 47.6±11.7 years;the course of disease ranged from 3 months to 32 months,with an average of 8.8±6.0 months.All patients were delayed surgery.According to different surgical methods,the above patients were divided into two groups,the laser group: transurethral holmium laser incision,a total of 52 cases,all of which were first surgery;anastomosis group: urethral stricture resection end-to-end anastomosis,a total of 60 cases,including 12 patients with restenosis after holmium laser incision.Comparative analysis of age,duration of disease,stenosis length,maximum urinary flow rate(Qmax),operative time,intraoperative blood loss,postoperative hospital stay,indwelling catheter days,restenosis rate,number of urethral dilatation,postoperative complications and other indicators.Results :The operation of 112 patients with urethral stricture was successfully completed.1.Comparison of general conditions: Age,duration of disease,length of stenosis,preoperative Qmax and other indicators,the comparison between groups was p>0.05,the difference was not statistically significant;2.Intraoperative comparison: The operation time of the anastomosis group was 92~310 min,with an average of 158.3±46.5 min.The operation time of the laser group was 20~66 min,with an average of 40.7±12.5 min.The difference between the groups was statistically significant(P<0.01).The anastomosis group estimated the bleeding volume to be 90~410ml,with an average of 175.3±64.4ml.The laser group estimated the bleeding volume to be 5~70ml,with an average of 31.3±15.8ml.The difference between the groups was statistically significant(P<0.01);3.Comparison of hospitalization period: The incidence of incision infection,local hematoma,bladder irritation and postoperative hospital stay in the anastomosis group was higher than that in the laser group,the difference was statistically significant(p<0.01);the incidence of urinary tract infection in the laser group was slightly lower than the anastomosis group,but the difference was not statistically significant(p>0.05);4.Long-term follow-up comparison: After 6 months of follow-up,the urethral restenosis rate(26.9%)was higher in the laser group than in the anastomosis group(5.0%),and the difference between the groups was statistically significant(P<0.01).After 12 months of follow-up,the urethral restenosis rate(63.5%)was significantly higher in the laser group than in the anastomosis group(8.3%),and the comparison between the groups was statistically significant(P<0.01);the restenosis rate(36.4%)was higher in the laser group than in the anastomosis group(3.7%)in patients with a stenosis length ?1.0 cm,the restenosis rate(83.3%)was significantly higher in the laser group than that in the anastomosis group(12.1%)in patients with a stenosis length >1 cm,the difference between groups was statistically significant(p<0.01);in the anastomosis group,patients with stenosis length ?1 cm had similar restenosis rates with stenosis length >1 cm,and the difference was not statistically significant(P>0.05),in the laser group,the restenosis rate(83.3%)in patients with stenosis length >1 cm was significantly higher than in patients with stenosis length <1 cm(36.4%),and the difference was statistically significant(P<0.01).The time of indwelling catheter and postoperative Qmax of the laser group was less than that in the anastomosis group,and the difference was statistically significant(p<0.01).The number of postoperative urethral dilatation was higher in the laser group than in the anastomosis group,and the difference was statistically significant(p<0.01).The incidence of postoperative erectile dysfunction(ED),transient urinary incontinence and delayed bleeding in the anastomosis group was slightly higher than that in the laser group,and the difference was not statistically significant(p>0.05).Conclusion:1.End-to-end anastomosis of urethral stricture can be used as the “gold standard” for surgical treatment of PFUDD,especially for patients with complex diseases such as stenosis length >1cm or severe atresia.The curative effect is certain;2.The long-term effect of transurethral holmium laser incision for the treatment of PFUDD is not ideal,and its efficacy is negatively correlated with the length of stenosis.The rate of restenosis after surgery is as high as 83.3%.3.Holmium laser incision has the advantages of simple operation,small damage and quick recovery.It can be applied to patients with simple PFUDD who can not tolerate open surgery and have a stenosis length?1cm.It is necessary to strictly control the surgical indications in order to improve long-term surgery efficacy.