外傷性尿道断裂に対する内視鏡的尿道再建術にて尿管用切除鏡が有用であった1例

Abstract

A 19-year-old man sustained a fracture of the left ischial rami and disruption of the membranous urethra when a car hit him against a wall. A suprapubic tube was placed and was used for reconstruction of the disrupted urethra 3 months later. Eighty days after the injury, an 11.5 F ureteral resectoscope was inserted through the open cystostomy tract. Simultaneously, a 11 F pediatric cystoscope was inserted via urethra. Using the "cut to the light" procedure, the scar tissue was incised with sharp strokes of the ureteral resectoscope revealing the distal urethral lumen. Sequentially, urethral dilatation to 24 F was performed over a 0.038 Teflon-coated guide wire following insertion of a 24 F urethral catheter. The urethral catheter was removed 22 days after the operation. Direct vision urethroscopy was performed at 1- to 2-week intervals for 3 months. At present 13 months after the operation, he performs 18 F urethral self-dilation and has been free of voiding complaints. The ureteral resectoscope is useful for endoscopical reconstruction of urethral disruption.