| Objectives:Nowadays, traffic accident and trauma grow in number, especially the probability of the pelvic and the urethral injury increases in war. According to the documents there is 5-10% urethral injury appeared after pelvis fracture, and 10% of the urethral injury lies in posterior urethra, about 80% urethral injury will come into urethral stricture. The posterior urethral stricture is difficult to treat because it lies in the very deep pelvic cavity. The common surgical approaches of treatment the posterior urethral stricture is via the superior part of pubis, the inferior part of pubis and perineum. This study is to evaluate the advantage and disadvantage of the three surgical approaches in treatment the posterior urethral stricture. Our objectives are:1. To compare the distance from via the midpoint superior margin of pubis, the midpoint inferior margin of pubis and perineum to the bulbi-membranous urethra joint, the apex of the prostate and the bladder neck. To compare the angles of membranous urethra correspondence of the three operative approaches point, and the angles of the prostatic urethra correspondence of the three surgical approaches point.2. To compare the damage scores via the superior part of pubis,the inferior part of pubis and perineum to expose the posterior urethra.3. to present the initial experience and results of via the inferior margin of pubis to treatment the of complex posterior urethral stricture. Materials and methods:1.Thirty-five adult male corpses were cut from the median sagittal plane of urethra into two parts ,choose the right side, measured the distance from the bulbi-membranous urethra joint(D) to the superior median margin of pubis (A) , to the inferior intermedial margin of pubis (B) and to the middle point of the both superior margin of ischial tuberosity in the perineum ( C ). and from the apex of prostate (E) to the same three points above. So did from the bladder neck (F) . Measured the angleEAD ( a1) formed from the line of the superior median margin of pubis ( A ) to the bulbi-membranous urethra joint (D) and to the apex of prostate(E) , the angle EBD ( a2) formed from the line of the inferior median margin of pubis (B) to the bulbi-membranous urethra joint(D) and the apex of prostate (E) ,the angle ECD (a3) formed from the line of he middle point of the both superior margin of ischial tuberosity in the perineum (C) to the bulbi-membranous urethra joint (D) and to the apex of prostate (E) .the angle FAE (B1 ) formed from the line of the superior median margin of pubis(A) to the apex of prostate (E) and the bladder neck ( F) ,the angle FBE (B2) formed from the line of the inferior median margin ofpubis (B) to ) to the apex of prostate (E) and the bladder neck (F) ,the angle ZFCE (B3 ) formed from the middle point of the both superior margin of ischial tuberosity in the perineum (C ) to the apex of prostate (E) and to the bladder neck (F) .2.Furthermore, twenty one adult male corpses were dissected with the surgical approaches via the midpoint superior part of pubis(7 cases), via the midpoint inferior part of pubis(7 cases) and via perineum (7cases)to expose the posterior urethra. The destructed constitutions and organs were marked and scored.3. 8 patients of complex posterior urethral stricture are researched. Patients from 7 to 55 years , mean 29.7 years, checked by cystourethrography, urethral retrogradiography and MR suggested the length of urethral stricture from 4 cm to 8 cm, mean 5 cm. Six patients appeared erective dysfunction. All detained bladder stoma tube, got more than three operations, treated via the inferior part of pubis. Excisied the inferior part trapezoid pubic of broad 4 cm and high 2 to 3 cm?kept lcm high bone bridge of the superior part of pubis, and used scrotum median septum pedicled skin flap to urethroplasty.Results:1. AD = (6.5 + 0.5) cm, BD = (2.2 + 0.5) cm, CD =( 3.4 + 0.6) cm, and BD < CD < AD (P<0.05 , SNK means); AE=(6.6+0.5)cm, BE=(3.0+0.5)cm, CE=(4.4+0.7)cm, and BE |
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