완전후부요도손상에서 비후두경을 이용한 일차적 내시경하 요도재배열술

Abstract

Primary realignment of complete urethral injury is a difficult procedure because of the pelvic bleeding and hematoma formation that occur during such injuries. In this study, we report the results of the treatment of complete posterior urethral injury by primary urethral realignment performed with the help of a rhinolaryngoscope. The primary urethral realignment was performed in the following sequence: (1) the proximal end of the obliterated urethra was directly observed with a flexible rhinolaryngoscope by using the antegrade approach; (2) a guidewire was passed through the flexible rhinolaryngoscope; (3) a 21 French (Fr) cystoscope with a 21 Fr urethrotome sheath was inserted through the distal urethra; (4) the obliteration of the urethra was confirmed using the guidewire; (5) the cystoscope was carefully inserted into the bladder, while the urethrotome sheath remained in the urethra; and (6) an 18 Fr Foley catheter was inserted into the bladder through the urethrotome sheath. This technique was investigated because it appears to be safe, simple, and minimally invasive. It is recommended for patients who have an unclear cystoscopic field due to pelvic bleeding or hematoma formation.