tailieunhanh - Urethral Reconstructive Surgery - part 5

Sau khi những chấn thương cấp tính, một ống suprapubic được chèn vào. Thủ tục bắt đầu với việc thay thế ống thông suprapubic với một âm thanh kim loại (hoặc linh hoạt cystoscope). B âm thanh suprapubic (hoặc linh hoạt cystoscope) là nhẹ nhàng thông qua thông qua các cổ bàng quang. | 83 11 Chapter 11 Endoscopic Realignment of Post-Traumatic Membranous Urethral Disruption B Fig. 11 .1A-E. Operative technique. A After the acute trauma a suprapubic tube is inserted. The procedure begins with the substitution of the suprapubic catheter with a metal sound or flexible cystoscope . B The suprapubic sound or flexible cystoscope is gently passed through the bladder neck. A 20-Fr urethrotome with half sheath is carefully advanced along the urethra. C With endoscopic control the urethrotome meets the tip of the metal sound or flexible cystoscope inside the pelvic hematoma. D Fluoroscopic control is used during the procedure. E The urethrotome reaches the bladder following the suprapubic instrument which is slowly retracted. A fenestrated catheter is inserted through the half sheath. A suprapubic drainage is left In an review of 871 cases Koraitim 1 evaluated the morbidity of different treatment of post-traumatic urethral disruption. For suprapubic cystostomy overall the incidence of stricture was 97 the incidence of impotence was 19 incontinence occurred in 4 of cases. For early or immediate surgical realignment overall the incidence of stricture was 53 the incidence of impotence was 36 incontinence occurred in 5 . However caution must be exercised when comparing retrospective series published over more than 40 years. The treatment of disruption is not related to the incidence of impotence and incontinence which are rather due to trauma itself 14 . Open surgery performed immediately after the trauma might impair potency because of iatrogenic damage of neurovas- 84 Chapter 11 Endoscopic Realignment of Post-Traumatic Membranous Urethral Disruption Fig. . A Combined antegrade and retrograde urethrocystogram after the trauma shows complete urethral disruption. B Retrograde urethrogram 15 days after endoscopy realignment with extravasation of contrast medium into pelvic hematoma. C Retrograde urethrogram 30 days after endoscopic realignment. A slight .