10 CATHETER REALIGNMENT VERSUS SUPRAPUBIC CYSTOSTOMY + DELAYED URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURIES: A GOAL-ORIENTED RETROSPECTIVE COMPARISON

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Traum & Reconstructive Surgery (1)1 Apr 201310 CATHETER REALIGNMENT VERSUS SUPRAPUBIC CYSTOSTOMY + DELAYED URETHROPLASTY FOR PELVIC FRACTURE URETHRAL INJURIES: A GOAL-ORIENTED RETROSPECTIVE COMPARISON Reynaldo Gomez, Oscar Storme, Laura Velarde, and Carlos Finsterbusch Reynaldo GomezReynaldo Gomez Santiago, Chile More articles by this author , Oscar StormeOscar Storme Santiago, Chile More articles by this author , Laura VelardeLaura Velarde Santiago, Chile More articles by this author , and Carlos FinsterbuschCarlos Finsterbusch Santiago, Chile More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1384AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Catheter realignment (CR) and suprapubic cystostomy + delayed urethroplasty (SC+DU) are accepted strategies for the management of pelvic fracture urethral injuries (PFUI). The goals of management in our institution are to obtain a satisfactory urethral reconstruction, free of recurrent stricture, with preservation of urinary continence and erectile function and in one single surgical procedure. We retrospectively compared the efficiency of each strategy to reach the proposed goals and the number and type of the surgical procedures required. METHODS We reviewed the charts of all PFUI patients treated from March 1986 to August 2012. For uniformity, we included only those cases managed entirely at our institution. One of two strategies was used: Strategy 1 (S1) included CR under fluoroscopy at the time of the emergency retrograde urethrography or as an open procedure at the time of the trauma laparotomy; no patient was taken to the operative room for the solely purpose of CR. Catheter was left 2 to 12 weeks. Strategy 2 (S2) included emergency percutaneous placement of a suprapubic cystostomy and delayed urethroplasty (DU) 3 to 30 weeks later. Only patients with untouched urethra were included, therefore failed CR eventually managed by SC+DU were excluded. Since DU is a complex, experience-requiring procedure, all DU cases were included, including the learning curve. Selection was not randomized but left to the discretion of the attending urologist. RESULTS There were 104 PFUI patients in the study period, 61 of which fulfilled the inclusion criteria (18 in S1 and 43 in S2). Average age was 34 years (15-69y). No patient was lost to follow up and no patient required supracrural rerouting or transpubic urethroplasty. The 15 patients who fail in S1 were rescued with a perineal urethroplasty in 10 and with 1 to 6 DVIU in the other 5 cases (30 procedures in total, 2 per patient). The 4 patients who fail S2 were resolved with 1 to 3 DVIU (6 procedures in total, 1.5 per patient). CONCLUSIONS Although the number of partial injuries was significantly larger in S1, S2 strategy was consistently more efficient to solve the problem in terms of recurrent stricture and the number and complexity of the surgical procedures required. S1 S2 p Number of patients 18 43 Average Follow Up (mo.) 85(2-289) 94(3-294) 0.73 Partial injuries 10(56%) 1(2.3%) <0.05 Stricture failure 15(83.3%) 4(9.3%) <0.05 Erectile Dysfunct.(%) 53 45 0.78 Incontinence 1(5.6%) 0 0.3 Rescue operations 30 6 <0.05 Total number of surgeries/patient 2.7 1.1 <0.05 Achievement of goals 3(17%) 22(51%) <0.05 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e4 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reynaldo Gomez Santiago, Chile More articles by this author Oscar Storme Santiago, Chile More articles by this author Laura Velarde Santiago, Chile More articles by this author Carlos Finsterbusch Santiago, Chile More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...