后尿道

  • 简介
  • 讲座
  • 论文
  • 常见问题
  • 手术效果
anatomia02
男性尿道分为前尿道和后尿道。后尿道从膀胱颈延伸到尿道远端括约肌，又可以分为尿道前列腺部和尿道膜部。前尿道从尿道远端括约肌延伸到尿道外口，分为尿道球部，尿道阴茎部和舟状窝。
讲座1

骨盆骨折尿道缺损患者的初步评估与治疗
01/10/2007
罗马-意大利
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讲座2:
骨盆创伤后尿失禁
第23届欧洲泌尿外科学会（EAU）年会
男性尿失禁分会
2008年3月26日至29日
米兰-意大利
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讲座3:
后尿道成形术
第三届国际尿道重建外科研讨会
2008年4月11日至12日
里约热内卢-巴西
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讲座4:
Chirurgia dell’uretra posteriore
曼图亚-意大利
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讲座5:
外伤性后尿道损伤。骨盆骨折后尿道缺损。
法国泌尿学协会会议
ESU课程：泌尿系损伤
20/11/2008
巴黎-法国
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讲座6:
后尿道损伤的急诊处理–手术方式及专家意见
Muljibhai Patel医院 “尿道重建”
2012年6月19至20日
纳迪亚德，古吉拉特，印度
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讲座7:
骨盆骨折尿道缺损患者的急诊与后期治疗
第9届阿拉伯泌尿外科协会年会
第7届国际约旦泌尿外科协会年会
2011年11月22日至24日
约旦，安曼
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论文1
Urethral trauma: radiological aspects and treatment options.
J Trauma. 1987 Mar; 27(3):256-61  

Experience with treatment of 38 patients in an early phase with urethral trauma is presented. The site of injury was the penile urethra in three cases, the bulbous urethra in seven, and the prostatomembranous urethra in 28. Different surgical procedures were used, according to the site and the extent of urethral damage and the presence of associated lesions. All patients with penile and bulbous urethral trauma were cured and only one has diminished sexual potency, while in the posterior urethral group nine were cured, and 19 developed strictures requiring further surgical treatment. Total impotence developed in 17 and partial impotence in one patient. Another case presents urinary urge incontinence.
论文2
Posterior urethroplasty in children.
Eur Urol. 1987;13(1-2):110-5.  

A series of 33 posterior urethral strictures in children is presented. The etiology was traumatic in 31 cases and iatrogenic in 2. Complex strictures were treated by a transpubic approach (20 cases) or by a posterior scroto-urethral inlay (1 case). Simple strictures were directly treated via the perineum: by a push-in technique (6 cases); by end-to-end anastomosis (3 cases); by a skin pedicled tube urethroplasty (1 case); by free skin graft (1 case), and by endoscopic urethrotomy (1 case). The use of omentum, employed in 19 cases, is considered a necessary step in transpubic urethroplasty. Favorable results were observed in 18 out of 20 transpubic procedures, in 8 out of 9 perineal urethroplasties and in 3 out of 4 other techniques, with an overall success rate of 87.8%.
论文3
Long-term results of anterior and posterior urethroplasty with actuarial evaluation of the success rates.
J Urol. 1997 Oct;158(4):1380-2.  

Purpose: We analyzed the long-term results of different urethroplasty techniques.
Materials and methods: We performed a retrospective review of 98 patients who underwent different procedures for anterior (78) and posterior (20) urethral strictures. Mean followup was 53 months. A total of 20 patients underwent end-to-end anastomosis (group 1), 30 underwent 1-stage procedures (group 2), 28 underwent 2-stage procedures (group 3), and 20 underwent bulboprostatic anastomosis (group 4). The results were analyzed using Kaplan-Meier curves and log rank test.
Results: The success rate was 95% for group 1, 93.4% for group 2, 78.6% for group 3, and 70% for group 4. Statistical evaluation of the actuarial success rates failed to show significant differences among the 4 groups.
Conclusions: The stricture recurrences were uniformly distributed over time. Urethroplasty patients must be followed for the rest of their lives.
论文4
History and Evolution of Transpubic Urethroplasty:
A Lesson for Young Urologists in Training
Eur Urol 2007; 52:1290 – 1292  

1. 问： 此项手术的麻醉方式是什么？
答: 经口气管插管的全身麻醉。

2. 问： 手术时间多长？
答: 约3小时。

3. 问： 手术后是否有勃起、生育问题或者尿失禁的风险？
答: 如果骨盆骨折甚至急诊手术时没有伤及膀胱颈，尿失禁情况罕见，后尿道重建书是安全的。术前的影像学检查可以很好的显示膀胱颈的情况。骨盆骨折和尿道破裂的患者会有不同程度的勃起功能障碍。后尿道重建术可能会引起勃起功能障碍。如果膀胱颈没有损伤，生育功能不受影响。

4. 问： 手术后住院时间是多长？
答: 一般来讲，5到7天

5. 问： 术后多长时间可以拔除尿管和耻骨上造瘘管？
答: 尿管至少保留至术后4周，直至术后首次尿路造影显示正常。耻骨上造瘘管需保留2个月，直至第二次术后尿路造影显示正常。

6. 问： 恢复期有什么特别需要注意的问题么？
答: 在恢复期，抗生素的使用一般持续到尿管拔除以后。同时，长途坐车旅行，重体力劳动、性生活以及运动是暂时需要避免的。

7. 问： 术后什么时候可以恢复工作、性生活以及运动？
答: 在拔除尿管之后，根据情况逐步恢复即可。

8. 问： 手术以后立即骑自行车或是摩托车是否可行？
答: 不提倡术后马上骑车、骑马。

9. 问： 术后饮食需要注意些什么？
答: 啤酒以及烈性酒精饮品，巧克力，可可，坚果和贝类都尽量避免。