透視ガイド下に内視鏡的尿道形成術を行った外傷性完全尿道断裂の1例

Abstract

A 76-year-old man injured in a car accident was admitted with urinary retention and urethral bleeding. Cystoscopic findings revealed disruption of the bulbous urethra and we performed cystostomy. At sixty days after the injury, we performed endoscopic urethroplasty with a steel needle puncturing from the proximal end of the disruption to the distal end under the guidance of C-Arm fluoroscopy. We removed the urethral catheter at the 37th day after surgery and then performed urethral dilation for postoperative urethral stricture. Retrograde urethrocystography showed no urethral stricture at 5 months after surgery. The patient had no dysuria or urinary incontinence. Endoscopic urethroplasty generally needs some guiding device to perform urethrotomy. C-Arm fluoroscopy and transluminal puncture were used in this case and proved useful for guidance from the proximal to the distal end of the urethral disruption. In particular, three dimensional imaging could demonstrate clearly the direction of the needle, making it easier to perform endoscopic urethroplastic surgery safely. Endoscopic urethroplasty which is minimally invasive for patients can be performed with shorter operating time and less blood loss than open surgery by urologists used to endoscopic treatment. Endoscopic surgery can be useful for selected patients of advanced age, in poor general condition, or with severe complications.