Complex Posterior Urethral Disruptions: Management by Combined Abdominal Transpubic Perineal Urethroplasty

Pratap, Akshay; Agrawal, Chandra Shekhar; Tiwari, Awadhesh; Bhattarai, B.; Pandit, Rakesh; Anchal, Nitish

doi:10.1016/s0022-5347(05)00974-2

Cited by 52 publications

(39 citation statements)

References 18 publications

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“…None of our patients developed penile shortening or chordee even after extensive urethral mobilizations. Only 1 patient in our series developed a decreased quality of erections postoperatively, and this is in contrast to 3 of 21 patients reported by Pratap et al [15] . This is due to special precautions we take during dissection around the prostate and avoiding dissection behind the prostate.…”

Section: Discussioncontrasting

confidence: 91%

Transpubic Urethroplasty for Complex Posterior Urethral Strictures: A Single Center Experience

Gupta¹,

Mishra²,

Dogra³

et al. 2009

Urol Int

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Aim: To review our experience and outcome of transpubic urethroplasty for complex posterior urethral strictures. Patients and Methods: 19 patients, mean age 17.8 (6–35) years, were treated with transpubic urethroplasty over the last 6 years. All had traumatic etiology (15 due to road traffic accidents and 4 due to falls from height). Mean stricture length was 4.4 (3.0–6.0) cm. All had a history of some intervention earlier. Three had rectourethral fistula, and 2 sinus tract in perineum which was connected to the periurethral cavity. One had a long fistulous tract connected through the anus to the anterior abdominal wall. One patient each had urethrocutaneous fistula, periurethral cavity and osteomyelitis of the pubic bone. Results: 16 of 19 (84.2%) patients had excellent outcomes with no evidence of stricture. Three had acceptable outcomes with some evidence of stricture. The mean operative time was 3.2 (2.5–4.0) h and average blood loss was 650 (500–900) ml. The mean hospital stay was 7.6 (6–12) days and average follow-up was 30 (7–66) months. Two patients developed mild wound infection. One patient each developed epididymoorchitis, perineal hematoma, fecal fistula and urine leak. One patient failed to void, and one patient developed erectile dysfunction. Conclusion: Transpubic urethroplasty is an excellent approach for patients with complex posterior urethral strictures.

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Section: Discussioncontrasting

confidence: 91%

Transpubic Urethroplasty for Complex Posterior Urethral Strictures: A Single Center Experience

Gupta¹,

Mishra²,

Dogra³

et al. 2009

Urol Int

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“…Rare cases of complex strictures (2 post-trauma cases since 1996) still require a combined abdomino-perineal approach. 14 In our series 10 patients had undergone primary realignment before urethroplasty, all treated since 1996, representing 16% of the patients since 1996. These patients did not have a significant difference in stricture length from those who did not undergo primary realignment, and we do not have the impression that primary realignment facilitates subsequent urethroplasty among those in whom realignment fails.…”

Section: Discussionmentioning

confidence: 91%

Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

et al. 2007

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Purpose: Management of posterior urethral disruption due to pelvic trauma can be quite challenging and is the subject of ongoing controversy. This study presents an update of the University of California, San Francisco experience with delayed anastomotic posterior urethroplasty for management of these injuries. Materials and Methods:Since 1979 all patients undergoing posterior urethroplasty by a single surgeon at University of California, San Francisco and its affiliated hospitals have been entered prospectively into a patient registry. For this cohort descriptive statistics were calculated and recurrence was analyzed with the Kaplan-Meier method. Success was defined as no recurrence (by symptoms and/or retrograde urethrogram) or a mild recurrence managed successfully with a single internal urethrotomy. Results: A total of 134 male patients were analyzed with a mean of 32.9 and a median of 12 months followup. Mean patient age at surgery was 34.8 years. Of the patients 35% had undergone at least 1 prior procedure for stricture including prior urethroplasty in 16%. In addition, 22% required partial pubectomy and 4% a combined abdominal-perineal approach with total pubectomy. Of patients with a closed bladder neck on urethrography 34% vs 7% of those with an open bladder neck required pubectomy (p Ͻ0.001). Stricture length tended to be longer in pubectomy cases (mean 3.2 vs 2.1 cm by urethrography, p ϭ 0.055). Of the patients 14% experienced recurrent stricture at a mean of 12 months, 42% of whom were treated successfully with a single urethrotomy. The overall success rate allowing 1 direct vision internal urethrotomy was 93%. Conclusions: Anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and stricture disease even after multiple prior procedures.Key Words: urethra; urethral stricture; anastomosis, surgical; wounds and injuries P osterior urethral injury complicates up to 25% of pelvic fractures arising from blunt pelvic trauma. 1 These injuries pose a significant management challenge, aggravated by the frequently severe extent of associated organ injuries, initial medical instability of many patients, distortions of pelvic and lower urinary tract anatomy, and the potentially extensive fibrotic response to urinary extravasation. Multiple approaches to these patients have been used in past and recent series. Patients treated at or referred to UCSF undergo initial suprapubic cystostomy urinary diversion and some patients referred within the last 10 years have also had an unsuccessful attempt at primary realignment. In this article we present our experience with delayed perineal anastomotic urethroplasty for treatment of these patients in the last 25 years. METHODS All operations were performed by a single surgeon (JWM).The technique for anastomotic posterior urethroplasty has been reported previously. 2,3 Key aspects of management include accurate preoperative definition of the stricture, which is usually possible via retrograde and antegrade urethrography (RUG/VCU...

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“…He described excising an entire anterior wedge of pubis using a Gigli saw (31,32). Inferior wedge pubectomy will have been completed perineally, and this-combined with retropubic bone removal-will provide wide anterior access, which facilitates anastomosis and access to the pelvic floor to manage the complicating features that were the indication for this approach (33). We think that entire wedge pubectomy or inferior wedge pubectomy should be selected based on the complexity of local condition, such as surrounding scar tissue, the degree of exposure.…”

Section: The Combined Transpubic-perineal Approachmentioning

confidence: 99%

Complex Posterior Urethral Stricture

Sa¹,

Xu²

2011

Current Concepts of Urethroplasty

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Complex Posterior Urethral Disruptions: Management by Combined Abdominal Transpubic Perineal Urethroplasty

Abstract: Combined abdominal transpubic perineal urethroplasty is a safe procedure in children and adults. It allows wide exposure to create a tension-free urethral anastomosis without significantly affecting continence or potency. Complications of pubic resection are now rarely seen.

Cited by 52 publications

References 18 publications

Transpubic Urethroplasty for Complex Posterior Urethral Strictures: A Single Center Experience

Transpubic Urethroplasty for Complex Posterior Urethral Strictures: A Single Center Experience

Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

Complex Posterior Urethral Stricture

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