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Abstract: The patient in this case is a 47-year-old male who came to our hospital because his urethra was damaged due to a car accident 2 years ago, and after surgery to repair it, it was complicated by urethral stricture, and he sought medical treatment everywhere, but it did not have much therapeutic effect. After the surgery, the patient was discharged after 6 weeks of hospitalization and continued to follow up as an outpatient, and he is recovering well.
Basic information】Male, 47 years old
Type of disease】Urethral stricture
Hospital】Xiang Ya Hospital of Central South University
Date of consultation】September 2021
Treatment plan】Surgical treatment (oral mucosal urethroplasty)
Treatment Period】6 weeks of hospitalization and continuous outpatient follow up
Effectiveness】The condition improved, and the discomfort basically disappeared.
I. Initial consultation
The patient was 47 years old and complained that he had been injured in a car accident 2 years ago, resulting in a broken urethra and inability to urinate, so he went to a local hospital for cystostomy and urethral repair surgery, but the results of the surgery were not good and he was still unable to urinate after the surgery, and he has been left with a cystostomy tube. After discussing with the patient and his family, he was admitted to our department with urethral stricture, and the relevant tests were completed and a treatment plan was formulated.
II. Treatment history
According to the patient’s basic condition, cystourethrography was performed, and the contrast agent was obviously obstructed down to the bulb of the urethral corpus cavernosum, and the contrast agent was injected through the urethral orifice, and the contrast agent was obstructed retrograde to the bulb of the urethral corpus cavernosum. Considering that the patient had failed several surgical procedures, a more suitable oral mucosal urethroplasty was performed, in which the free oral mucosa was sutured to the cut anterior urethral spongiosome of the stenosis with successive locked edges, and a patch was made to widen the stenosis. Postoperatively, the catheter was retained and the patient’s vital signs were closely monitored to minimize the incidence of postoperative complications such as infection and urinary fistula.
III. Treatment results
The patient’s surgery was relatively smooth, and no intraoperative complications occurred. The patient recovered well with strict and proper postoperative care. The local swelling and numbness of the oral cavity gradually disappeared 2 weeks after surgery. The urethrogram was performed 6 weeks after surgery without any abnormalities, so the catheter was removed and the patient reported that he could urinate normally without any abnormal symptoms such as difficulty in urination or thinning of the urine line. After discharge from the hospital, the urethra continued to be open and no recurrence of urethral stricture was observed.
IV. Notes
I was happy to see the patient’s good postoperative results. Since the patient took his own oral mucosa as the material, I instructed the patient to rinse his mouth with saline until the intraoral wound healed and to avoid excessive mouth opening movements until it healed to promote its healing. Fasting for 2 days and gradual transition from a liquid diet to a regular diet were also required to promote intraoral wound healing. In addition, because of the special surgical site, early bedtime activities are not recommended, and patients are instructed to stay in bed for 1 week after surgery. Heavy physical labor and intercourse should be prohibited for 3 months after discharge from the hospital to avoid inducing bleeding in the surgical area and even leading to surgical failure.
V. Personal insight
The patient in this case underwent urethral repair surgery after urethral rupture, but the surgical result was not good, and he was transferred to many places for treatment, but the efficacy was not good, and the urethral stricture still existed after the surgery. This is also very helpful for the recovery.