Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases / 中华男科学杂志

<p><b>Objective</b>To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture.</p><p><b>METHODS</b>We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results.</p><p><b>RESULTS</b>The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation.</p><p><b>CONCLUSIONS</b>Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.</p>

Clinical comparative study of urethral anastomoses and ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure / 中国医师进修杂志

Objective To investigate the clinical effects and safety of urethral anastomoses and ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure. Methods Ninety patients with urethral straddle injury and catheter placement failure were chosen and divided into A group (45 patients, choosing urethral anastomoses) and B group (45 patients, choosing ureteroscopy urethral realignment). The operation time, intraoperative blood loss, hospital staying time and peri-operation complications in both groups were compared. Results The operation time, intraoperative blood loss, hospital staying time in B group were significantly lower than those in A group: (26.15 ± 10.41) min vs. (71.93 ± 14.50) min, (22.37 ± 7.41) ml vs. (50.70 ± 13.25) ml, (3.22 ± 0.97) d vs. (5.19 ± 1.43) d, P<0.05. After 6 months′follow-up, the clinical indicators in peri-operation period of B group were significantly better than those in A group (P<0.05). The complications incidence in B group was significantly lower than that in A group: 2.22%(1/45) vs. 13.33%(6/45), P <0.05. Conclusions The technology of ureteroscopy urethral realignment in the treatment of urethral straddle injury and catheter placement failure can efficiently shorten the operation time, reduce the degree of trauma and accelerate the rehabilitation process, and it is helpful to reduce the risk of complications in peri-operation period.

Treatment of urethral complete broken injury with double ureteroscopic urethral realignment / 中国医师进修杂志

Objective To investigate the efficacy and safety of treatment of urethral complete broken injury with double ureteroscopic urethral realignment.Methods A clinical data of 26 cases of urethral complete broken injury who had underwent double ureteroscopic urethral realignment were retrospectively analyzed.Results The patients were confirmed by urinary tract imaging for urethral complete broken injury.The catheters were inserted successfully into bladders and removed at 6 weeks after operations.The operative time was 25-53 (39.0 ± 12.4) min.Twenty patients gained fluent urination after removal of catheter,with maximum urine flow 17-28 ml/s after 6 weeks.Six cases had urethral stricture.Among them,2 cases received urethral expansion,3 cases received transurethral cold knife incision,and 1 case received urethral anastomosis.All of them gained fluent urination.Conclusion Treatment of urethral complete broken injury with double ureteroscopic urethral realignment is feasible,superior and reproducible.

Clinical observation for emergency realignment of urethra with straddle injury under the guidance of ureteroscope / 中国中西医结合急救杂志

Objective To evaluate the effectiveness and safety of emergency realignment of urethra with straddle injury under the guidance of ureteroscope. Methods The clinical results of 39 patients with urethra straddle injury having the failure of inputting a urethral catheter from August 2007 to August 2013 in Central People's Hospital of Tengzhou City,Shandong province were retrospectively investigated,and according to the difference in method of operation,the patients were divided into two groups. In group A,there were 27 patients who underwent the first stage perineal urethra repair and anastomosis operation,and in group B,there were 12 patients who underwent urethral realignment operation and insertion of a catheter under the guidance of ureteroscope. The operation time, amount of bleeding in operation,incidence of complications such as urethral stricture,erectile dysfunction,as well as postoperative hospital stay were compared between the two groups. In addition,we searched PubMed/MEDLINE, EMBASE,Wanfang database,China journal full-text database(CNKI),VIP database and China outstanding master's/doctoral dissertation database from which we selected research literatures from 2000 to 2013 on emergency realignment of urethra with straddle injury and conducted Meta-analysis by Revman 5.2 software. Results Compared to group A, the operation time and postoperative hospital stay were significantly shortened in group B〔operation time(minutes):26±15 vs. 71±18,postoperative hospital stay(days):2.6±1.2 vs. 5.2±1.9,both P0.05〕. And patients suffering from urethral stenosis were treated with postoperative transurethral expansion and followed up for 6 to 12 months,including 1 case of urethra expansion invalid to switch to open surgery. Related literatures were researched for Meta-analysis,and 4 literatures were enrolled. Meta-analysis results further confirmed that urethral realignment was more effective than urethral anastomosis for urethral injury〔odds ratio(OR)=2.30,95% confidence interval(95%CI)1.07 - 4.95,P=0.03〕. Conclusion Performing urethral realignment operation under the guidance of ureteroscopy is a better operation in the treatment of urethral straddle injury,having the advantages of shorter operation time,less trauma,quicker recovery and fewer complications.

Urethral realignment for treating early urethral injury under the guidance of ureteroscope / 中国医师进修杂志

Objective To summarize the clinical experience of urethral realignment for treating early urethral injury under the guidance of ureteroscope,and evaluate its curative effect.Methods Twenty-nine male patients with urethral injury were selected,and 12 patients of posterior urethral injury,17 patients of former urethral injury.All the patients were treated with urethral realignment under the guidance of ureteroscope,postoperative indwelling catheter 3-8 weeks,every 7-16 days changed diameter increase 2 F the catheter 1 time.Results The 29 patients with urethral injury were a indwelling catheter success,all patients were no incontinence after operation 3 months.In the 29 patients,27 patients were urination unobstructed after catheter removal,2 patients were appeared urine line slim after 2 weeks,the 2 patients were normal urination after short urethral expansion.Conclusions The urethral realignment for treating early urethral injury under the guidance of ureteroscope has simple,lower complication,rapid recovery,better effect.The continuous flexible progressive urethral expansion and the strict nursing,which can effectively reduce the occurrence of urethral stricture.

Results of Primary Endoscopic Urethral Realignment as a Treatment of Urethral Injury According to the Injury Site / 대한비뇨기과학회지

PURPOSE: There are a variety of open surgical and endoscopic methods to the treatment of urethral injuries. The objective of our study is to evaluate the efficacy of primary endoscopic urethral realignment according to the injury site. MATERIALS AND METHODS: Twenty eight patients with urethral injuries(23 anterior and 5 posterior) were treated by primary endoscopic urethral realignment from March 1990 to August 1997. According to the injury site, age distribution, etiology of injury, associated injuries, time to operation, operating time, duration of urethral Foley catheterization, maximal flow rate, postoperative complications and treatment of post-realignment stricture were reviewed. RESULTS: The age range of our patients was from 20 to 86 years(mean 45.0). Among the 28 patients, 23 were anterior and 5 were posterior urethral injuries. Pelvic bone fracture was associated in 1 patient(20.0%) in the anterior urethral injury group, while 5 patients(100%) in the posterior urethral injury group. The mean time after injury to realignment was 1.9 days (range 0 to 9) and the mean operating time was 53.9 minutes in the anterior urethral injury group(range 20-190) and 79.0 minutes in the posterior urethral injury group(range 25-170). The mean duration of urethral Foley catheterization was 24.5 days in the anterior urethral injury group and 61.4 days in the posterior urethral injury group. The mean maximal flow rate after catheter removal was 31.4ml/sec in the anterior urethral injury group and 24.6ml/sec in the posterior urethral injury group. Of the 23 patients, 9 patients(39.1%) had post-realignment strictures in the anterior urethral injury group and 8 were treated with visual urethrotomy, and only one patient was required open urethroplasty. Of the 5 patients, 4 patients(80.0%) had post-realignment strictures in the posterior urethral injury group and treated with visual urethrotomy. CONCLUSIONS: Primary endoscopic urethral realignment is a safe and simple technique with minimal mobidity regardless of injury site. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for open surgical methods. Finally, most post-realignment strictures can be treated successfully with visual internal urethrotomy with or without occasional sound dilation.