儿童外伤性后尿道狭窄或闭锁的手术治疗

目的　总结儿童外伤性后尿道狭窄或闭锁的手术治疗的体会。方法　后尿道损伤术后再狭窄或闭锁 38例患儿 ,其中经会阴尿道修复术 3例 ,经耻骨会阴联合尿道修复术 2 6例 ,经耻骨尿道修复术 4例 ,带蒂阴囊皮管代尿道 4例 ,经会阴和尾路尿道吻合及尿道直肠瘘修补术 1例。结果　38例患儿随访 1～ 8年 ,其中排尿正常者 34例 ( 89.5 % )。 1例经耻骨会阴联合尿道修复术尿失禁 ;2例经耻骨尿道修复术再次尿道狭窄 ;1例带蒂阴囊皮管代尿道术后排尿通畅 ,同时合并尿道会阴瘘。结论　①经耻骨会阴联合切口手术途径更适合于复杂性外伤性后尿道狭窄或闭锁的小儿 ;②顺行和逆行尿道造影时可能过多估计尿道狭窄的长度 ;③经会阴尾路联合途径对尿道直肠瘘修补失败者不失为一个好的选择     

儿童后尿道损伤的诊断与治疗

目的　探讨儿童后尿道损伤更为有效的诊治方法和并发症的防治。方法　回顾性总结分析 1990年 4月～ 2 0 0 3年 12月四川大学华西医院收治的 5 5例儿童后尿道损伤的临床资料 ,38例( 6 9.0 % )获得 6个月～ 14年 (平均 6年 4个月 )的随访。结果　本组几乎均为陈旧性后尿道损伤。尿道狭窄组 10例行尿道带管扩张 ,7例治愈 ,3例改行尿道拖入吻合术 ;尿道闭锁组 ,采用后尿道拖入吻合术 2 9例 ,近期成功率 10 0 % ,远期结果 ,排尿欠通畅 3例 ,部分性尿失禁 4例 ,反复发生附睾炎 2例 ,阳痿 2例 ;经耻骨后尿道成形术 14例 ,近期成功率 86 % ,远期结果 ,排尿困难 2例 ,排尿欠通畅 2例 ,不完全性尿失禁 2例 ,附睾炎 1例 ,阳萎 1例 ;3例阴囊中缝皮瓣拖入间置术中 ,2例发生间置尿道狭窄 ;2例经会阴尿道吻合术疗效满意。结论　尿道狭窄经恰当处理后会有良好的效果 ;经会阴后尿道拖入吻合术在儿童后尿道闭锁的治疗中效果满意 ,经耻骨后尿道吻合术更适用于较复杂的后尿道闭锁治疗 ;我们赞同儿童后尿道断裂伤后早期即时的耻骨上膀胱造瘘 ,延期尿道修复手术的观点     

尿道套入法治疗 小儿外伤性后尿道狭窄或闭锁17例

目的探讨尿道套入法治疗小儿外伤性后尿道狭窄或闭锁的疗效。方法使用尿道套入法治疗小儿外伤性后尿道狭窄或闭锁共17例,均为男性,平均年龄9岁,尿道瘢痕长约0．5～2．5cm。结果术后16例排尿通畅,无尿失禁。1例术后出现排尿困难,经尿道扩张处理后治愈。结论本方法操作简单,手术时间短,效果好,是治疗小儿外伤性后尿道狭窄或闭锁较佳的手术方法。     

小儿后尿道狭窄的诊治体会

目的 探讨小儿后尿道狭窄病因学、尿道损伤部位及外科手术处理的特点。方法 对23例小儿后尿道狭窄的损伤原因、损伤部位、术式选择及其并发症的处理进行回顾性总结。结果 23例患儿，其中8例是由于肛门直肠手术误伤所至后尿道狭窄；所有患儿均行后尿道吻合术，15例痊愈、4例尿道狭窄、2例漏尿、2例尿失禁。结论 外伤是造成小儿后尿道损伤的主要原因，肛门直肠手术误伤是造成婴幼儿后尿道损伤的重要原因；经会阴尿道吻合术是治疗小儿后尿道狭窄的最佳手术方式。     

经耻骨会阴联合途径治疗男童复杂性后尿道狭窄或闭锁

目的：评价经耻骨会阴联合途径治疗男童复杂性后尿道狭窄或闭锁的临床疗效。方法：15例复杂性后尿道狭窄或闭锁的男童均行经耻骨会阴联合途径后尿道端端吻合术，其中3例合并尿道直肠瘘，结果：15例均一次手术成功，术后均能自主排尿，排尿通畅，10例术后最大尿流率（MFR）平均12．5ml/s，3例术后有尿失禁现象，其中2例6个月后尿失禁现象明显改善，11例随访6－36个月，排尿仍通畅，无需尿扩，步态平衡，结论：该术式适于尿道狭窄段较长或伴有尿道直肠瘘，假道等复杂性后尿道狭窄，尤其是以往经会阴途径后尿道修复手术失败者。     

经会阴修复男童急性外伤性后尿道断裂

目的 探讨经会阴尿道吻合术治疗男童急性外伤性后尿道断裂的效果.方法 总结1994至2007年我院采用经会阴尿道吻合术修复男童急性完全性尿道断裂共24例资料,年龄4～15岁,平均6.5岁,本组后尿道损伤均因骨盆骨折导致,在牛命体征平稳的情况下,手术时问为外伤后10 h至7 d.经术前自尿道外口造影诊断后尿道完全性断裂.所有病例均急诊行经会阴尿道端端吻合术.术后留置导尿管2～4周.结果 24例新鲜尿道外伤除1例手术后有尿道狭窄,手术后3个月做内切开;另外1例手术后随诊有轻微压力性尿失禁外,其余病例一次手术均获成功,排尿良好.结论 经会阴修复男童急性外伤性后尿道断裂效果满意.     

尿道套入法治疗小儿外伤性后尿道狭窄事闭锁17例

目的 探讨尿道套入法治疗小儿外伤性后尿道狭窄或闭锁的疗效。方法 使用尿道套入法治疗小儿外伤性后尿道狭窄或闭锁共１７例,均为男性,平均年龄９岁,尿道瘢痕长约０．５－２．５ｃｍ,结果 术后１６例排尿通畅,无尿失禁。１例术后出现排尿困难,经尿道扩张处理后治愈。     

尿道套入法治疗男童外伤性后尿道闭锁

目的　介绍和评价尿道套入法治疗男童外伤性后尿道闭锁。方法　对 1994年 1月～2 0 0 3年 12月以尿道套入法治疗的 2 5例外伤性后尿道闭锁进行回顾性分析。结果　 2 5例患儿后尿道闭锁段长度 1～ 2cm ,切除闭锁段瘢痕组织后无法直接行对端吻合 ,故将远端尿道套入 ,固定 ,留置导尿管 6周左右 ,拔管后均排尿通畅 ,其中 6例经 1～ 2次尿道扩张 ,2 5例均无尿失禁。结论　尿道套入手术方法简单 ,是治疗男童尿道缺损段较长及经手术修复失败的后尿道闭锁的一种良好的手术方法     

冷热刀联合应用治疗儿童外伤后尿道狭窄

儿童尿道细嫩柔软，一旦发生狭窄或闭锁，其处理极为棘手，对外伤性长段或严重后尿道狭窄以往多采用尿道成形术，而经尿道手术(TUR)治疗小儿严重尿道狭窄则少有报道。     

经尿道内切开治疗男童后尿道狭窄与闭锁

探讨经尿道内切开治疗男童外伤性后尿道狭窄与闭锁的适应证及记忆合金支架的应用。材料与方法１；５３例患儿年龄４－１２岁，平均７岁，狭窄３５例，闭锁１８例。其中切开后放置钛镍螺遽记忆合金支架２３例。结果；随访３个水－８年。未放记忆合金支架组治愈２３例，好转３例，尿失禁３例，改开放手术１例；放置记忆合金支架台愈７例，好转１例，带支架正常排尿８例，改开放手术７例。结论；本法适用于治疗短段尿道狭窄或闭锁，狭窄     

Post-traumatic posterior urethral stricture in children: how to achieve a successful repair

ObjectiveComplex post-traumatic posterior urethral strictures in children constitute a major challenge to the pediatric urologist. Surgical repair depends primarily on the length of the urethral obliteration. Resection with end-to-end anastomosis is the usual procedure in the face of a short segment stricture. Transpubic urethroplasty and substitution urethroplasty are currently used to treat extensive and complex urethral strictures. We present our experience of the management of children presenting with post-traumatic posterior urethral stricture.Patients and methodsFifty boys with a mean age of 9 years (6–13) with obliterative urethral stricture were operated on during May 1999 to August 2006. Short posterior urethral stricture was treated by excision and end-to-end anastomotic urethroplasty in 40 boys. Long posterior urethral stricture was managed by combined inferior pubectomy in three, transpubic urethroplasty in four and tubed penile fasciocutaneous flap in three.ResultsWith a mean follow-up of 4.5 years (6 months–7 years), all children who underwent perineal anastomotic urethroplasty were successfully repaired. Transpubic urethroplasty was associated with a re-stricture in one child 6 years following the repair. In the group repaired by tubed fasciocutaneous flap, we encountered a distal anastomotic stricture accompanied by a huge proximal diverticulum which needed revision in one child, and another diverticulum with multiple stones in another who was treated successfully.ConclusionAnastomotic urethroplasty in children is feasible with good results. Proper evaluation is needed to choose the best surgical technique for each patient. Tubed fasciocutaneous flap carries the highest complication rate.     

Traumatic posterior urethral disruptions in boys: experience with the perineal/perineal—transpubic approach in ten cases

The management of traumatic posterior urethral disruption in children has ranged from primary realignment/repair to delayed urethroplasty. The operative approach may be perineal or transpubic; the advocates of either cite comparable outcome. The anatomic considerations in a child differ from the adult and the management is individualized .We present our experience with the perineal/perineal–transpubic approach in the management of traumatic posterior urethral disruptions in ten boys. A preliminary suprapubic cystostomy was followed by a delayed urethroplasty after comprehensive investigations to delineate the pathoanatomy of the disruption. The urethroplasty began with a perineal exposure and progressed to varying extents to achieve a satisfactory urethral anastomosis. Four cases of bulbomembranous disruption were repaired by perineal approach, whereas six cases of prostatomembranous disruption required a perineal–transpubic approach. Permutations of operative techniques (circumurethral mobilization, corporeal separation/urethral rerouting, pubectomy and omentoplasty) were used. The follow-up assessed micturition patterns, urinary continence and penile erections. At a mean follow-up of 5 years (1.5–12 years), all ten boys void in a good stream and are continent. All have normal penile erections, posture and gait. The paper discusses the rationale and outcome of our management.     

Post-traumatic urethral strictures in children: What have we learned over the years?

BackgroundUrethral stricture presents an uncommon but difficult urological problem in the pediatric population. Treatment protocols are different from in adults due to anatomical considerations.Material and methodsA thorough manual and Medline search was conducted to review the existing literature on post-traumatic pediatric urethral strictures, with key words: stricture, children, post-traumatic, urethroplasty, pediatric.ResultsOpinion early on was that, due to the confined perineum, high incidence of supramembranous injury resulting in less predictable distraction defects of the posterior urethra and a high incidence of prostatic displacement, transperineal urethroplasty is technically more difficult than in adults and thus the transpubic approach is more feasible. Recent reports revealed that both approaches resulted in almost the same clinical outcomes for children with post-traumatic posterior urethral strictures.ConclusionThe ideal reconstruction for the treatment of post-traumatic posterior urethral strictures in children is bulboprostatic anastomosis. This procedure should be initially attempted through the perineum in every case. A transpubic procedure should be done only when tension-free anastomosis cannot be accomplished through the perineum.     

儿童复杂性尿道狭窄的治疗

目的 探讨儿童复杂性尿道狭窄手术方法的选择及成功的关键。方法 25例复杂性尿道狭窄采用不同的手术方法治疗30次，其中采用口腔粘膜管状重建尿道3例。口腔粘膜补片尿道成形3例；经耻骨径路尿道端端吻合11例，膀胱壁瓣尿道成形2例；经会阴径路尿道端端吻合8例；双阴唇带蒂皮瓣Ⅰ期尿道成形2例；带蒂包皮内板Ⅰ期尿道成形1例。结果 术后随访2-36个月。平均18.5个月。一次手术后排尿通畅20例。术后效果不佳5例。经再次手术后排尿通畅4例。结论 儿童尿道狭窄手术方法的选择应根据尿道狭窄段的长短，位置选择合适的术式；口腔粘膜具有取材方便。创伤小，有较强的抗感染力的优点，是一种较好的尿道替代物。     

Our experience,technique and long-term outcomes in the management of posterior urethral strictures

PurposeTo share our experience, technique and long-term outcomes in posterior urethral stricture management.Materials and methodsThirty-seven boys with post-traumatic posterior urethral stricture underwent resection and end-to-end anastomosis through pre-anal coronal approach or in combination with trans-pubic approach from January 2000 to December 2011. Follow up included symptomatic evaluation by micturating cystourethrogram and retrograde urethrogram in all patients, and urethroscopy in patients with voiding symptoms.ResultsPre-anal coronal approach was used in 29 (78%) cases and in 8 (21%) cases it was combined with trans-pubic approach. In 33 (89.1%) patients it was first attempt, while in 4 (10.9%) it was redo surgery. Two patients required buccal mucosal graft to bridge the deficient urethra. Patient age was 5–17 years (mean 10.8 years). Mean follow up was 48.5 months (range 6–132 months). Thirty-two (86%) patients were symptom free. Failed repairs were successfully managed by urethral dilation in 3 and by redo urethroplasty in the remaining 2. All patients were continent. There was no chordee, penile shortening or urethral diverticula.ConclusionsResection and end-to-end anastomosis of posterior urethral stricture is possible through pre-anal coronal incision; however, if slightest difficulty is envisaged in creating a satisfactory end-to-end anastomosis, extension to trans-pubic approach should be done.     

尿道内切开术治疗男童外伤性尿道狭窄

目的　探讨应用尿道内窥镜下尿道内切开术 ,治疗男童外伤性后尿道瘢痕性狭窄的效果。方法　回顾性总结 2 1例陈旧性外伤性后尿道狭窄患儿 ,经尿道内切开术治疗的结果 ,分析手术方法、术中注意事项、手术成功率等。结果　 2 1例中 ,12例经 1次尿道内切开治愈 ,6例经 2次手术治愈 ,1例经 3次手术治愈 ,最终由尿道内切开术治愈 19例 ,成功率为 90 .5 % ,患儿排尿顺畅 ,尿流率正常。结论　经尿道镜下尿道内切开术治疗男童外伤性后尿道狭窄 ,是一种微创、简便、安全、有效的方法