後尿道完全性斷裂之處理是頗具爭論性的,現今最標準的處理方法是立刻行膀胱造廔術,三個月後再做尿道整形術。文獻上報告,大多認為後尿道斷裂後直接行尿道修補術,有較高之比例會發生尿道狹窄、陽痿或尿失禁,而且認為這些併發症大部份是因治療所引起,而不是傷害本身。即時性膀胱造廔術併延遲性尿道修補術被認為可降低陽痿和尿失禁的發生率。但是我們的報告並不贊同此觀點。從民國七十年七月到八十五年五月,我們收集15年來之28例後尿道完全性斷裂的病例,追蹤時間六個月到四年,所有的病人受傷之前都是可勃起和可禁尿的。受傷機轉,22例車禍、5例跌傷、和1例壓碎傷。逆行性尿道攝影術用來診斷後尿道完全性斷裂。我們把病人分為兩組:A組和B組。A組病人有7例接受即時性膀胱造廔術併延遲性尿道修補術,這些病人是生命現象不穩定或高手術危險群。B組病人有21例接受即時性尿道修補術,這些病人是生命現象穩定且是低手術危險群。A組病人有2例陽痿(28%),B組病人有1例併發尿失禁。我們發現這兩組病人,陽痿和尿失禁的比率沒有明顯差別。回顧其他文獻的佐證,我們認為只要病人的生命現象穩定且適合手術,小心柔和的實行即時性尿道修補術是安全和可接受的方法,而陽痿和尿失禁的產生似乎是受傷當時的傷害所造成的,與初次處理方法無關。
The management of complete posterior urethral rupture continues to be controversial, and no single policy has received universal acceptance. As reported in the literature, management by initial cystostomy and delayed repair was assumed to decrease the incidence of impotence and incontinence; therefore was regarded as the standard procedure for complete posterior urethral rupture. Findings here failed to support this viewpoint. A review of experience with 28 consecutive cases of complete posterior urethral rupture in the past 15 years (from July 1981 to May 1996), included a follow-up ranging from six months to four years. As for the mechanism of injury, 22 patients were involved in motor vehicle accidents, 5 had falls and 1 had crush injury. All patients were potent and continent before injury. Retrograde urethrography was arranged to demonstrate complete posterior urethrography was arranged to demonstrate complete posterior urethral rupture. The 28 patients were divided into two groups. Group A: 7 patients had initial cystostomy and delayed repair, done when the patient was a poor surgical risk and hemodynamically unstable, and Group B: 21 patients had primary realignment with interlocking sound method, done when the patient was hemodynamically stable and in good surgical condition. Impotence was noted in 28% (2/7) of Group A; compared to 24% (5/21) of Group B. No incontinent patient was noted in Group A compared to 5% (1/21) in Group B. No significant difference in the rate of impotence and incontinence was noted between the two groups. It was found here that careful primary realignment of complete posterior urethral rupture is a safe procedure, producing an acceptable result, and that impotence and incontinence seemed to be related mainly to the initial injury.