经直肠超声检查在女性创伤性尿道狭窄诊断中的价值

目的 探讨经直肠超声检查(transrectal ultrasonography,TRUS)对女性创伤性尿道狭窄的诊断价值.方法 应用TRUS和尿道造影检查对15例女性创伤性尿道狭窄患者进行检查,并与手术结果进行对照.结果 15例超声结果与术中所见一致;6例尿道造影与手术结果不一致.结论 TRUS在女性创伤性尿道狭窄诊断中有较高的诊断价值.     

尿道狭窄超声、造影及手术的对比研究

对40例尿道狭窄患者行B型超声及尿道造影诊断。术中发现,尿道狭窄的长度与B超结果相符(p>0.05)。X线尿道造影5例未显示后尿道,3例出现尿道狭窄假象,与手术结果相比有显著差异(p<0.05)。以20例正常青年男性尿道超声为对照组。球部尿道狭窄经会阴超声探查比经直肠超声容易诊断。与尿道造影相比,超声诊断方法简便迅速,图像清晰,重复性好,医生和患者免受X线损害,并能清楚显示出尿道狭窄周围瘢痕组织的轮廓,有助于选择治疗方式。     

排尿性MR尿道成像对损伤性尿道狭窄的诊断价值

【摘要】目的：探讨排尿性MR尿道成像对损伤性尿道狭窄的诊断价值。方法：对因排尿困难前来本院就诊的73例男性患者进行排尿性MR尿道成像,利用生理盐水或尿液充盈尿道,在患者排尿时进行MR平扫及增强扫描。所有患者均行X线尿道造影及手术治疗。观察尿道狭窄位置、程度、长度、有无瘢痕形成及其周围组织结构关系。对排尿性MR尿道成像、X线尿道造影所测得的尿道狭窄的长度与手术所见尿道狭窄的长度进行统计学分析。结果：57例后尿道狭窄,16例前尿道狭窄;12例尿道完全离断伴有断端错位,38例尿道闭锁无错位,14例尿道重度狭窄,9例尿道中度狭窄;损伤尿道周围均有不同程度瘢痕组织。排尿性MR尿道成像对尿道损伤的定位与X线尿道造影及术中所见结果一致,对尿道周围组织结构的显示与术中所见一致、明显优于X线尿道造影。对于尿道狭窄的长度的判断,MR尿道成像测得的狭窄长度［(1.634±0.6481)cm］与术中测得的狭窄长度［(1.615±0.6843)cm］差异无统计学意义（t=1.242,P=0.2183）,X线尿道造影测得的狭窄长度［(2.100(1.990,2.290)cm］ 与术中测得的狭窄长度差异具有统计学意义(P<0.0001)。结论：排尿性MR尿道成像可以准确显示狭窄尿道及其周围组织结构,指导临床手术方式的选择。     

多种腔镜技术联合治疗男性创伤性尿道狭窄

目的 探讨多种腔镜技术联合治疗男性创伤性尿道狭窄的临床疗效和手术技巧.方法 联合应用尿道镜冷刀切开、经尿道瘢痕电切和输尿管镜内切开技术治疗男性创伤性尿道狭窄47例,其中前尿道狭窄29例,后尿道狭窄18例,并对临床资料进行回顾性分析.结果 43例腔内手术一次成功,1例第二次手术成功,术后排尿通畅,无尿失禁、尿瘘和再手术;3例后尿道狭窄腔内手术未获成功,改行耻骨上膀胱切开会师戳通尿道后用电切镜切除瘢痕,术后1例最大尿流率长期稳定在9～12 ml/s,1例依赖尿道扩张维持排尿,1例不能排尿保留膀胱造瘘管.结论 多种腔镜技术联合应用治疗男性创伤性尿道狭窄成功率高、安全性好,远期疗效稳定,值得推广应用.     

等离子体柱状及环状电极汽化切割治疗尿道狭窄或闭锁

2004-01~2006-09我科联合应用等离子体柱状及环状电极汽化切割治疗尿道狭窄或闭锁18例,现将结果报告如下。1资料与方法1.1临床资料:本组男性18例,年龄17~83岁,平均44岁,病程3个月~8年,平均2.5年。狭窄原因:车祸伤8例,坠落伤4例,前列腺术后狭窄5例,炎性尿道狭窄1例。治疗史:10例曾行尿道会师术,3例曾行尿道吻合术,15例曾行尿道扩张术。入院前已行膀胱造瘘14例。相关检查及结果:所有患者均行排尿性膀胱尿道造影和逆性尿道造影,骨盆正侧位X线片,确诊为尿道狭窄或闭锁,均在尿道球部以上(包括球部),狭窄和闭锁长度0.3~2 cm,平均1.2 cm。其中尿道…     

52 例外伤性尿道狭窄的治疗体会

自 198 5年至 2 0 0 0年 ,笔者分别用开放手术和腔内手术治疗创伤性尿道狭窄 5 2例 ,取得较好的疗效。临　床　资　料一、一般资料本组均为男性 ,年龄 16～ 6 8岁 ,平均 33岁。病程 4个月～ 3年 ,平均 1年2个月。骑跨伤致尿道球部狭窄 34例 ,其中 5例曾行开放尿道吻合术 ,均经多次尿道扩张无效。交通伤或挤压伤 18例引起尿道膜部狭窄 ,系尿道会师术后 ,拔除导尿管排尿不畅或不能排尿而保留膀胱造瘘管所致 (其中 7例合并骨盆骨折 ,6例系膜部狭窄开放术后再狭窄 ,均行多次尿道扩张无效 )。经尿道镜、尿道造影或膀胱尿道造影证实尿道球部狭窄 2…     

双平面腔内超声联合新型微泡显影剂超声造影诊断肛瘘内口的价值

目的 :探讨维生素C与碳酸氢钠混合液作为新型微泡显影剂时的肛瘘超声造影特征及对肛瘘内口的诊断价值。方法:选择60例临床初步诊断的肛瘘患者,先行双平面腔内超声检查,再行双平面腔内超声联合新型微泡显影剂造影检查,以手术结果为标准,对比2种检查方法显示率。结果:腔内超声检查内口显示率73.3%(44/60),腔内超声联合造影检查为93.3%(56/60),腔内超声联合造影明显高于腔内超声(P0.05)。2种检查方法主瘘管均显示,双平面腔内超声示19例存在分支瘘管,双平面腔内超声联合新型微泡显影剂造影示21例存在分支瘘管,两者比较差异有统计学意义(P 0.05)。结论:与双平面腔内超声相比,利用新型微泡显影剂行超声造影显著提高了内口显示率,对主瘘管及分支瘘管诊断有一定作用,可为临床手术治疗提供重要依据。     

男性创伤性复杂性后尿道狭窄的手术治疗

目的 探讨男性创伤性复杂性后尿道狭窄的手术治疗效果.方法 回顾性分析479例诊断为创伤性复杂性后尿道狭窄患者的临床资料.其中422例Ⅰ期行尿道狭窄段切除+端端吻合术,57例行带血管蒂阴囊皮瓣后尿道成形术.结果 手术时间平均115 min(90～140 min),术中平均出血量225 ml(100～300 ml).无一例需术中输血.术后平均随访15个月(12 ～24个月),422例行尿道吻合术的患者中,386例排尿通畅,36例排尿不畅的患者中,再次行排泄性尿道造影提示21例是因为吻合口瓣膜形成,15例因局部存在狭窄环,行尿道瓣膜切除或狭窄环内切开术,术后恢复良好.57例行后尿道成形术患者中,45例排尿通畅;9例患者出现前尿道与皮管吻合口狭窄,其中4例行尿道扩张后好转,5例行尿道狭窄内切开术后好转;3例出现皮管与后尿道或膀胱颈吻合口狭窄,其中1例经尿道扩张后好转,2例行尿道狭窄内切开术后好转.结论 Ⅰ期尿道狭窄段切除+端端吻合术是治疗创伤性复杂性后尿道狭窄的主要方法,病情不允许时可行后尿道成形术.     

三维肛肠超声扫描结合瘘管造影定位诊断肛瘘临床研究

目的：探讨三维肛肠超声扫描结合瘘管造影定位诊断肛瘘的准确性。方法选择31例经手术确诊的肛瘘病人,术前应用三维肛肠超声扫描和瘘管造影的资料进行分析。结果三维超声检查,单纯型、复杂型、低位型肛瘘分别为16例、15例、11例,均与手术结果符合,15例高位肛瘘中经括约肌13例、括约肌间1例、括约肌外1例,有13例与手术结果符合。31例肛瘘患者三维肛肠超声后,其瘘管的形态和走行特点、瘘管内口均能完整清晰显示。超声结合瘘管造影三维重组对肛瘘内口检查的准确性为93.55％。结论三维肛肠超声结合瘘管造影可以对肛瘘进行定位诊断。     

多层螺旋CT多维重建在泌尿系统疾病诊断中的应用

目的:探讨多层螺旋CT多维重建技术在泌尿系统疾病诊断中的应用价值.方法:采用16排螺旋CT薄层扫描并利用多维重建技术对50例泌尿系统疾病患者进行检查.泌尿系结石40例,肾癌2例,肾盂癌1例,膀胱癌2例,肾盂、输尿管交界处狭窄1例,肾损伤4例.结果:50例患者均获明确诊断.泌尿系结石CT多维重建可显示高密度结石致密影及结石形态、大小,与手术切开取石或体外碎石排石结果一致.5例肿瘤CT多维重建或MPR检查显示不规则软组织块影,并能显示管壁增厚,狭窄或团块样改变.膀胱肿瘤尚能立体显示腔内侵袭深度及与周围组织关系,与术中所见和术后病理结果相符.1例肾盂输尿管交界处狭窄能清晰显示狭窄部位、程度,肾盂积水情况.4例肾损伤患者可显示肾损伤程度、血肿范围以及周围脏器损伤情况.结论:多层螺旋CT多维成像分辨率高、检查时间短、侵袭性小、可增加图像立体感,使病变显示更为清晰,可作为泌尿系统疾病最有价值的诊断方法之一.     

A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures

AIM: This prospective study was undertaken to evaluate the abnormalities of the male anterior urethra using high-resolution ultrasound (sonourethrography) and to compare the efficacy with that of retrograde urethrography (RGU) using operative findings as the gold standard. MATERIALS AND METHODS: Seventy patients with symptoms of lower urinary tract obstruction underwent RGU followed by sonourethrography. The sonologist was blinded to the findings of RGU. The parameters studied were compared with the intra-operative findings as gold standard, and the sensitivity, specificity and overall accuracy for the procedures were calculated. Chi-square test and kappa statistics were used where appropriate. RESULTS: All patients found to have urethral stricture disease by RGU were also detected by sonourethrography and confirmed intra-operatively. In the estimation of stricture length, RGU showed a lower sensitivity (60-80%) for lengths 1-4 cm, compared with sonourethrography (73.3-100%). Spongiofibrosis was detected by sonourethrography with a sensitivity of 77.3-83.3%. All the false tracts and calculi detected at sonourethrography were confirmed at surgery, whereas RGU showed a low sensitivity in their detection. The complications encountered during the procedures were pain, urethral bleeding and contrast intravasation. The frequency of pain during RGU was greater (p < 0.001); however, the difference in frequency of bleeding after the two procedures was not significant (p < 0.5). CONCLUSION: RGU and sonourethrography are equally efficacious in detection of anterior urethral strictures. Further characterization of strictures in terms of length, diameter and periurethral pathologies, like spongiofibrosis and false tracts, is done with greater sensitivity using sonourethrography as compared with RGU, with the added benefit of lower incidence of complications.     

Optimisation of sonourethrography: the clamp method

Purpose

To describe the clamp method for performing retrograde sonourethrography (RSUG) and contrast-enhanced voiding sonourethrography (CE-VSUG) via the transperineal approach in male adults.

Materials and methods

Prospective study of 113 males (14-86 years) with urethral strictures confirmed by urethrography who received sonourethrography via the clamp method between 2011 and 2015. The characteristic parameters of the quantitative variables were calculated and a comparative analysis of the qualitative variables was conducted using the McNemar test.

Results

RSUG was performed successfully in all the cases (n = 113) and detected 49 cases with anterior urethral strictures; the strictures in the proximal bulbar cone in five of them (10.2%) were not visualised on retrograde urethrography (RUG) (p < 0.05). CE-VSUG was performed successfully in 97 cases and observed posterior urethral strictures in 82; the bladder neck strictures in 6 of them (7.3%) were not observed on voiding cystourethrography (VCUG) (p < 0.05). Retrograde bladder filling was achieved in approximately 6 min.

Conclusion

The clamp method enables RSUG and CE-VSUG to be performed simply, effectively and painlessly by a single operator. It also allows the evaluation of cases with urethromeatal alterations (stricture, hypospadias and meatotomy).

Key Points

? The clamp method enables RSUG to be performed simply and painlessly. ? The clamp method requires only one operator and allows assessing urethromeatal alterations. ? RSUG shows greater capacity for detecting anterior urethral strictures than RUG. ? The clamp method achieves retrograde bladder filling in approximately 6 min. ? CE-VSUG shows greater capacity for detecting strictures than VCUG.

     

Role of MDCT in evaluation of urethral lesions

Objectives

To evaluate the role of multidetector computed tomography (MDCT) in the diagnosis of urethral lesions.

Methods

Thirteen CT urethrography examinations on 13 male patients were performed with 4-MDCT, over a 15 month duration. These patients were clinically examined and a urethral lesion was suspected. The study included recently traumatized patients and patients with suspected urethral lesions. The study was performed by retrograde urethral injection or during micturition after IV contrast injection. 3D-volume rendering (VR) images and VR-multiplanar reconstruction (MPR) sagittal images and virtual images were done.

Results

Out of the 13 patients, two patients were diagnosed having avulsed prostatic urethra.Nine patients were diagnosed having urethral strictures: two at the bulbous urethra (one of them associated with fistulous stricture), five at the membranous urethra (one of them having associated hypospadias) and two at the prostatic urethra. Two postoperative patients with hypospadias were evaluated, one with glans collection and the other with urethral stricture. One patient was diagnosed having urethral neoplasm.

Conclusion

MDCT urethrography is an accurate method in delineating small lesions, site, length, degree of strictures and extraluminal structures.     

Imaging of male urethra

The male urethral imaging and pathology is not widespread in the radiology literature because this part of the urinary tract is easily studied by urologists with clinical or endoscopic examinations. Ultrasonography and MR imaging are increasingly being used in association with voiding cystourethrography and retrograde urethrography. The posterior urethra is being studied with voiding cystourethrography or voiding sonography which allows the detection of bladder neck pathology, post-surgical stenosis, and neoplasms. The functional aspects of the bladder neck and posterior urethra can be monitored continuously in patients with neuromuscular dysfunction of the bladder. The anterior urethral anatomy and pathology is commonly explored by retrograde urethrography, but recently sonourethrography and MR imaging have been proposed, distending the lumen with simple saline solution instead of iodinated contrast media. They are being used to study the urethral mucosa and the periurethral spongy tissue which can be involved in the urethral pathologies such as strictures, diverticula, trauma, and tumors. Imaging has an important role to play in the study of the diseases of the male urethra since it can detect pathology not visible on urethroscopy. The new imaging techniques in this area, such as sonography and MR, can provide adjunct information that cannot be obtained with other modalities.     

MR urethrogram versus combined retrograde urethrogram and sonourethrography in diagnosis of urethral stricture

Objectives: To compare the accuracy of magnetic resonance (MR) urethrogram versus combined RUG and sonourethrography (SUG) in diagnosis urethral stricture with evaluation of their impact in management choice.Material and methods: From March 2006 through February 2007; 30 male patients (mean age, 45 ± 18 years, range 15-75) with clinically suspected urethral stricture. All patients underwent RUG, SUG and MR urethrogram.Results: The final diagnosis of the 30 cases included in our study, after endoscopy and surgical management, was classified into two main groups either isolated stricture (20 cases) or associated with other pathologies (9 cases). There was one case with normal urethral caliber at endoscopy. For the anterior stricture the sensitivity, specificity and overall accuracy of RUG was 91%, 90% and 90%, respectively and for the posterior stricture it was 89%, 91.7% and 90%, respectively. At SUG, all cases of anterior were detected with 100% accuracy while for cases of posterior stricture, the overall accuracy was 60%. MR urethrogram diagnosed all the cases of anterior and posterior stricture with exact delineation of its length except one case of normal caliber was diagnosed falsely at MR as anterior short segment urethral with 100% sensitivity, 91.7% specificity and 95% overall accuracy.Conclusion: MR urethrogram has comparable results with the combined RUG and SUG in diagnosing the anterior and posterior urethral strictures as regard the site and extension and degree of spongiofibrosis but MR is superior in diagnosis of associated pathologies with stricture.     

Comparison of radiographic and sonographic urethrography for assessing urethral strictures

The aim of this study was to compare radiourethrography (RUG) and sonourethrography (SUG) for assessment of urethral strictures and to evaluate whether RUG underestimates stricture length, as has been reported. Fifty-one men with suspected urethral strictures were evaluated by both methods performed consecutively. Stricture lengths and diameters measured by RUG were significantly greater (mean 22%, 30%) than those measured by SUG because of radiographic magnification. Both methods, however, detected a similar percentage lumen reduction and similarly graded stricture severity. Equally significant non-correlation between both methods for length measurements in the bulbar and penile urethra (p<0.001, R²=0.33 and 0.34, respectively) supported radiographic magnification. Previous inaccuracies appear to relate to RUG measurements of the central tight stricture (mean 44% of the entire length in our series), not the full stricture length. Use of sonographic contrast medium intra-urethrally improved the definition of long narrow strictures. The SUG gave information about peri-urethral tissues not provided by RUG. Once radiographic magnification was taken into account, there were no major differences in the assessment of urethral strictures by both methods. With correct measurement methods, RUG does not underestimate stricture length. For full assessment, the combination of RUG and SUG, which gives information about peri-urethral disease, is optimal in many patients.     

Anterior urethral strictures and retrograde urethrography: An update for radiologists

Urethral strictures are a relatively common affliction of men with the anterior urethra being most frequently affected. Anterior urethral strictures (AUS) typically present with obstructive voiding symptoms and appropriate management is often based on findings at cystourethroscopy and retrograde urethrography (RUG). In particular, determining the number, length, severity and location of urethral strictures is of pivotal importance. The accurate reporting of findings at RUG is dependent on a thorough knowledge of the urethral anatomy as well as recognizing periurethral structures that may opacify during the procedure. Obtaining a diagnostic, high-quality RUG study requires adherence to proper fluoroscopic technique as well as recognizing when to adjust or modify the technique to address pitfalls that may be encountered during the procedure. AUS may be treated by a variety of procedures including urinary diversion, transurethral procedures such as urethral dilation and internal urethrotomy and open surgical repair techniques termed urethroplasty. Some authors have recommended urethroplasty as first-line treatment given the high rate of stricture recurrence with other treatment options. Buccal mucosal grafts are a mainstay of modern urethroplasty. Familiarity with the commonly performed urethroplasty procedures allows radiologists to accurately assess the post-operative urethra thus guiding the management of these patients.     

爆炸伤所致尿道狭窄动物模型的建立

目的建立爆炸伤所致尿道狭窄动物模型。方法新西兰雄性兔26只，其中实验组（20只）切开阴茎与肛门间皮肤连接，以自制爆炸装置对尿道球部实施定位爆炸，造成尿道球部腹侧长约5—10mm局限性半壁毁损，缝合皮肤切口；对照组（6只）未实施爆炸，术后第2周和第4周行逆行尿道造影和尿道镜检查，同时间点取实验组损伤段尿道组织及对照组相应部位尿道组织进行病理组织学观察。结果实验组90％（18／20）尿道球部显示典型狭窄征象（狭窄段长约0．5-1．0cm，内腔缩小50％以上）；组织学显示狭窄段尿道上皮剥脱、缺失，发生明显纤维化增生；术后4周时尿道狭窄程度无明显改变。对照组显示正常尿道组织结构。结论此定位爆炸法能建立良好的爆炸伤所致尿道狭窄动物模型。     

Anterior urethral trauma: role of sonourethrography

We present a case of blunt anterior urethral trauma during sexual activity in a 20-year-old man. The patient had abundant urethrorrhagia, but there were no obvious clinical data to help locate the urethral lesion. Diagnosis was established by sonourethrography (SUG), which showed a coagulum in the urethral lumen from a small haematoma in the corpus spongiosum of the proximal pendulous urethra. No lesion was observed in the sonography performed previously without urethral distension or in the retrograde urethrography performed afterwards. The utility of SUG for early diagnosis of urethral contusion is analysed, and a novel technique for performing SUG is described. We believe that this procedure should be used routinely in the initial management of patients suspected with lesions of the anterior urethra.