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患者,男性,17岁,因排尿时肛门口喷尿17年入院。查体:发育正常,阴茎无畸形,双侧睾丸正常,胸膝位肛门6点齿状线下有一小孔,排尿时见尿液经该孔喷出,用F_(16)导尿管插入10cm导出尿液。KUB+IVP:左肾盂肾盏显影良好,膀胱无异常,右肾未显影。膀胱排尿期造影:后尿道显影不佳。尿道及重复尿道逆行造影发现尿道球部狭小,重复尿道连于前列腺部尿道。B超:右肾区未见肾脏影像,左肾正常。肾图:左侧肾功能正常,上尿路排泄通畅,右侧肾图呈低平曲线。术前诊断:左侧独肾,先天性完全型尿道重复畸形。入院一周后在持续硬膜外麻醉下行探查术,术中经阴茎尿道外口分别插入F_(14)导尿管和金属探杆均在尿道球部受阻,切开膀胱,未见小梁小房,右侧输尿管口缺如而左侧正常,膀胱颈可容小指尖,未发现另外的尿道内口。肛门处的重复尿道外口可插入F_(16)尿管经膀胱颈入膀胱,仅行膀胱造瘘,术后10天拔管出现。
Patient, male, 17 years old, admitted to the hospital for anal squashing for 16 years due to urination. Physical examination: normal development, no penile deformity, normal bilateral testis, chest ankle anus 6 points under the dentate line there is a small hole, urinary urine seep through the hole, with F_ (16) catheter inserted 10cm Export urine. KUB + IVP: Left renal pelvis calyx developed well, no abnormal bladder, right kidney is not developed. Bladder urinary phase contrast: posterior urethral development is poor. Retrograde urethra and urethral retrograde angiography found urethral small, repeated urethra connected to the urethra in the prostate. B-ultrasound: no kidney image of the right kidney area, left kidney normal. Renal chart: the left renal function is normal, upper urinary tract excretion, the right kidney showed a flat curve. Preoperative diagnosis: left kidney, congenital complete urethral deformity. One week after admission, continuous exploration of epidural anesthesia was performed. Intraoperative insertion of F_ (14) catheters and metal probes through the penile urethral orifice were obstructed in the urethral bulb and the bladder was incised. No trabecular cells and right Side of the ureter and lack of left normal, the bladder neck can accommodate small fingertips, no other urethral mouth was found. The urethra outside the mouth of the anus can be inserted into the bladder through the bladder neck through the F_ (16) catheter, and only the bladder fistula is removed. Extubation occurs 10 days after the operation.