外傷性尿道断裂に対する内視鏡的尿道再建術

Abstract

1)外傷性尿道完全断裂症例5例に対し, 内視鏡的尿道再建術を施行した. 2)5例中4例が良好な排尿状態をえた. 3)全例に術後内尿道切開術及び尿道ブジーを要した. 4)術後尿失禁やインポテンツといった合併症は認められなかった. 5)本術式が有効なのは欠損長が3cm以下の症例と考えられた.手術は受傷後3ヵ月経過してから施行すると再狭窄が生じにくかった

Endoscopic reconstruction was performed in 5 patients after complete traumatic disruption of the urethra. A prostatic urethra was disrupted in 1 patient, prostatic and membranous urethrae in 1 and bulbous urethra in 3. After endoscopic reconstruction, all patients required additional internal urethrotomy and urethral bougienage, but became able to void by themselves. Four patients had maximum flow rates between 13.8 and 41.9 ml/s. However, the other patient with an obliterated urethral segment of 4.6 cm had traumatic impotence preoperatively and a poor voiding status after reconstruction. None of the patients developed urinary incontinence or impotence associated with the operation. In conclusion, endoscopic reconstruction is recommended as the initial procedure for patients with obliterated segments smaller than 3 cm.