Optimising the outcome after anastomotic posterior urethroplasty

Koraitim, Mamdouh M.

doi:10.1016/j.aju.2014.12.006

Cited by 13 publications

(6 citation statements)

References 18 publications

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“…PFUI is associated with high rates of urethral stenosis, even in patients with successful PR, and its gold standard management is delayed urethroplasty . Delayed urethroplasty should not be attempted within 3–6 months of the initial trauma, because the local healing reaction has not been completed before this time, and the surgical dissection will be more difficult and the chance of a successful result might be less . Although some experts wait just 3–6 weeks before urethroplasty, no others suggest that a delay of <3 months is appropriate .…”

Section: Delayed Management For Pfuimentioning

confidence: 99%

“…2,28,32 Delayed urethroplasty should not be attempted within 3-6 months of the initial trauma, because the local healing reaction has not been completed before this time, and the surgical dissection will be more difficult and the chance of a successful result might be less. 26,32,50 Although some experts wait just 3-6 weeks before urethroplasty, 51 no others suggest that a delay of <3 months is appropriate. 26 Although transurethral procedures, such as urethrotomy or office-and self-dilation, are commonly utilized in general urological practice as delayed management and most urologists persevere with them for as long as possible, they are applicable only for short and nonobliterative stenosis and should not be repeated.…”

Section: Urethral Stenosismentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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Section: Delayed Management For Pfuimentioning

confidence: 99%

Section: Urethral Stenosismentioning

confidence: 99%

Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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“…To overcome this limitation, various specially designed instruments, suture needles, and retractors have been introduced for use during this procedure (15). The struggle to complete this anastomosis in the difficult conditions of poor access increases the risk of poor tissue handling and of performing anastomosis of doubtful integrity, resulting in poor outcome with its attendant burden on the patient, the surgeon, and the health system (6,16). Recurrence of posterior urethral fibrosis requiring further procedures or repeat reconstructions is common (17).…”

Section: Discussionmentioning

confidence: 99%

“…Among the factors contributing to the poor outcome of repair is poor access to the site of surgery due to the rigid configuration of the bony pelvis (5). The unyielding bony pelvis limits access to the proximal healthy urethral segment, increases the chances of incomplete excision of the fibrotic urethral segment, which compromises the integrity of urethral anastomosis, and impairs a successful tension-free anastomosis (6).…”

Section: Introductionmentioning

confidence: 99%

Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

Nnabugwu¹,

Ugwumba²,

Ilukwe³

2021

Ann Afr Surg.

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Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the medium- to longterm outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s (mean: 21 mL/s). The longest duration of follow-up was 34 months, and all patients were voiding satisfactorily. Conclusions: A satisfactory and durable outcome can be obtained from nibbling at the bone from the inferior margin of the pubic bone to achieve PIP. This is of interest to lower urinary tract reconstructive surgeons who have concerns with chiseling-out wedge of the inferior pubis. Keywords: Bone nibbling, Partial inferior pubectomy, PFUI, Posterior urethra, Urethral anastomosis

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“…Первичное отсроченное лечение травматических стриктур уретры, как правило, заключается в иссечении рубцово-изменённой уретры и наложении прямого анастомоза между здоровыми участками мочеиспускательного канала [4,8,12,13,14,15,16]. Данный подход позволяет ликвидировать диастаз длиной 2 -4 см за счёт мобилизации бульбозной уретры и её эластичности [17,18,19,20,21,22].…”

Section: Discussionunclassified

Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention

et al. 2021

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Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (> 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.

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Optimising the outcome after anastomotic posterior urethroplasty

Cited by 13 publications

References 18 publications

Management of male pelvic fracture urethral injuries: Review and current topics

Management of male pelvic fracture urethral injuries: Review and current topics

Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention

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