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  • Title: [Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases].
    Author: Han CX, Xu WJ, Li W, Yu ZY, Li JY, Lin XC, Zhao L.
    Journal: Zhonghua Nan Ke Xue; 2016 Jul; 22(7):613-616. PubMed ID: 28965378.
    Abstract:
    OBJECTIVE: To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. 目的: 探讨带外鞘引流腔镜下尿道会师术治疗尿道断裂的临床效果。方法: 带外鞘引流腔镜下尿道会师术是以Peelaway鞘为外鞘，以肾镜或李逊镜作为观察镜，外接生理盐水冲洗进行尿道会师的手术方法。利用该技术共治疗前、后尿道断裂患者21例，并对治疗效果进行分析。结果: 21例尿道断裂患者应用该方法进行尿道会师手术，成功20例，1例因尿道离断较长中转开放手术，术中均无明显冲洗液外渗。腔镜尿道会师成功20例患者中，前尿道断裂14例，手术时间（5.1±1.6） min，留置导尿管时间（26.0±5.1） d，尿道狭窄发生率57.1%，1例后期行尿道狭窄内切开治愈，余7例单纯行尿道扩张治愈，术后1年最大尿流率（18.8±1.8）ml/s；后尿道断裂6例，手术时间（15.8±7.5） min，留置导尿管时间均为8周，术后均继发不同程度尿道狭窄，均常规行尿道扩张，3例扩张后治愈，1例行经尿道狭窄内切开术治愈，2例后期行后尿道狭窄切除吻合术治愈。未再行开放手术的4例患者术后1年最大尿流率（17.9±1.9） ml/s。结论: 带外鞘引流的腔镜下尿道会师术可以保持手术视野清晰，减少冲洗液外渗，缩短手术时间，提高手术成功率，治疗前、后尿道断裂术后早期临床效果满意。.
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