Comparison of Immediate Primary Repair and Delayed Urethroplasty in Men with Bulbous Urethral Disruption after Blunt Straddle Injury

Abstract

PurposeThe aim of this study was to analyze the outcomes of immediate primary repair (IPR) compared with delayed repair (DR) after initial suprapubic cystostomy.Materials and MethodsWe reviewed the records of 60 patients with bulbous urethral disruption after blunt trauma from February 2001 to March 2011. Seventeen patients who presented in an acute injury state underwent IPR; 43 patients underwent DR after the initial suprapubic cystostomy. None of the patients had undergone previous urethral manipulation. We compared the outcomes, including stricture, impotence, and incontinence, between the two management approaches. We also measured the time to spontaneous voiding, the duration of suprapubic diversion, and the number of days spent in the hospital.ResultsThe median follow-up was 20.5 months (range, 13 to 59 months; mean, 23.3 months). Among 17 patients in the IPR group, strictures developed in 2 patients (11.7%), and among 53 patients in the DR group, strictures developed in 8 patients (18.6%, p=0.709). The incidences of impotence and incontinence were similar in both groups (17.6% and 0% in the IPR group vs. 27.9% and 4.6% in the DR group, p=0.520 and 1.000, respectively). The time to spontaneous voiding and the duration of suprapubic diversion were significantly shorter in the IPR group (average 27.3 and 33.4 days, respectively) than in the DR group (average 191.6 and 198.1 days, respectively; p<0.001 and <0.001).ConclusionsIPR may provide comparable outcomes to DR and allow for shorter times to spontaneous voiding and reduce the duration of suprapubic diversion.

Urotrauma: AUA Guideline

“…Stricture formation after straddle injury is very high and thus all patients undergoing urinary diversion require follow-up surveillance using uroflowmetry, retrograde urethrogram and/or cystoscopy. 129 …”

Emergency treatment of male blunt urethral trauma in China: Outcome of different methods in comparison with other countries

“…We did not find any such study in Chinese literature, but there is a study from Korea that compared primary repair with delayed repair. That study reported that in AUI, primary repair had comparable result with delayed repair [25] .…”

“…Table 1 listed the results of 23 studies in English literature [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] . The success rate of ESR in PUI ranged from 0% to 85.7%.…”

A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury

“…Comparing with delayed urethroplasty, 4 our approach has several advantages as this surgical procedure is (i) effective, safe, and quick; (ii) minimally invasive, avoiding extensive operations in severely injured patients; (iii) able to have spontaneous voiding 34.5 -6.9 days (ranging from 28 to 42 days) after surgery, compared with other procedures 25 ; (iv) not required to carry the preoperative long-term urethral catheterization for the delayed surgery, which avoids patients' inconvenience and decreases the possibility of UTI or stone formation; (v) avoids tissue damage such as ED [24][25][26][27] that might be ceased by delayed surgery; (vi) suitable for treatment in smaller hospitals with lack of advanced equipment (such as flexible ureteroscope); and (vii) shorter hospital stay (8.5 days) compared with delayed surgery (35.2 days). 32,33 The success rates of endoscopic realignment range from 72% to 100%. 4,28 Three patients in this study had urinary retention, which can easily be treated with suprapubic aspiration or catheterization.…”