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Abstract: In this case, the patient had a traumatic injury more than 20 years ago, which led to urethral injury, and the surgical treatment was not effective, but no special treatment was given until 20 days ago, when the discomfort worsened and did not improve after taking medication on his own, so he came to our hospital. He is currently under continuous outpatient follow-up.
Basic information】Male, 41 years old
Type of disease】Urethral stricture
Hospital】Central South University Xiangya Hospital
Date of consultation】December 2021
Treatment plan】Surgical treatment (endourethral stricture surgery, resection end anastomosis) + intravenous drip (cefradine for injection) + oral medication (vinpocetine tablets)
Treatment period】1 month of hospitalization and continuous follow-up
Treatment effect】The condition improved and the discomfort disappeared basically
I. Initial consultation
The patient was a 41-year-old male, who was injured in a car accident more than 20 years ago, resulting in a pelvic fracture that caused posterior urethral injury, so he went to a local hospital for urethral repair and urethral stricture resection end anastomosis. He complained of painful urination, thin urine line and dripping urine without any obvious cause 20 days ago, and his symptoms did not improve significantly after taking oral anti-inflammatory drugs. The outpatient urethrography indicated posterior urethral membrane and prostatic stricture, and pseudodiverticulum around the posterior urethral membrane, and the posterior urethral stricture was admitted to our department for surgery.
II. Treatment process
According to the location of the stricture and the patient’s condition, an endourethrotomy was performed for posterior urethral stricture. The patient’s physical condition was evaluated before surgery, and preoperative blood and urine routine, urine culture, liver and kidney function tests were performed to exclude contraindications to surgery, and cefradin for injection was given intravenously to prevent infection. During the operation, the internal lumen of the urethra was trimmed and attention was paid to protecting the external urethral sphincter, and a urinary catheter was left in place after the operation. After the operation, the patient returned to the ward safely, and was given cardiac monitoring to continuously monitor the patient’s vital signs, and continued antibiotic treatment to prevent postoperative infection; as well as oral administration of ethylene estradiol tablets to avoid penile erection, which could affect the healing of the surgical incision; at the same time, the bladder was continuously flushed to prevent blood clots from obstructing the urinary catheter.
III. Treatment results
The patient’s surgery was relatively smooth, and the catheter was continuously passed without urinary reflux, and the catheter was removed 1 month after surgery. The patient’s postoperative urination gradually returned to normal, and the symptoms such as painful urination, thin urine line and urine dripping that existed before the operation basically disappeared, and the erectile dysfunction caused by the operation was gradually recovered over time. During the continuous follow-up, there was no recurrence of postoperative urethral stricture for the time being, and no other uncomfortable symptoms appeared.
IV. Precautions
The patient’s vital signs were stable after surgery, but in order to prevent postoperative urethral stricture, so the patient was instructed to drink a lot of water, 2-3L per day, after the anus resumed venting, which can serve to flush the urethra and prevent infection and urethral stone formation. The patient’s urinary catheter was removed one month after surgery, and the patient’s urinary function gradually returned to normal, and the preoperative discomfort had basically disappeared, so the patient was very happy, and I was also happy for the patient’s improvement.
V. Personal insight
In this case, serious trauma such as car accident injury is the main cause of posterior urethral stricture, and the success rate of posterior urethral stricture surgery is not high, and it is easy to recur, just like the patient in this case, so even if the surgery is successful, the patient still needs to actively cooperate with follow-up care, such as increasing daily water intake and maintaining hygiene in the perineal area to reduce the chance of recurrence.