10 OUTCOMES OF ENDOSCOPIC REALIGNMENT OF POSTERIOR URETHRAL INJURIES AT A LEVEL 1 TRAUMA CENTER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 201110 OUTCOMES OF ENDOSCOPIC REALIGNMENT OF POSTERIOR URETHRAL INJURIES AT A LEVEL 1 TRAUMA CENTER Laura Leddy, Hunter Wessells, and Bryan Voelzke Laura LeddyLaura Leddy Seattle, WA More articles by this author , Hunter WessellsHunter Wessells Seattle, WA More articles by this author , and Bryan VoelzkeBryan Voelzke Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.071AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to examine the success of initial endoscopic realignment following blunt pelvic trauma. METHODS A retrospective review was performed of all patients with pelvic fracture urethral disruption defect (PFUDD) who underwent endoscopic realignment from 2004–2010 at a Level 1 trauma center. Retrograde urethrogram, flexible cystoscopy, and clinical suspicion aided diagnosis of PFUDD. Endoscopic realignment of the posterior urethra was performed when the patient was clinically stable. Subsequent need for urethral dilation, internal urethrotomy, posterior urethroplasty, or intermittent self-catheterization following urethral catheter removal was considered failure. Uroflowmetry, postvoid residual and cystoscopic evaluation were utilized to diagnose failure of endoscopic realignment. RESULTS Nineteen patients with PFUDD who underwent endoscopic realignment were identified. Mean age was 38 (median 36). Injury etiology included the following: 10 motor vehicle crashes, 4 crush injuries, 3 vehicle vs. pedestrian accidents, 1 snowboarding accident, and 1 motorcycle crash. The following posterior urethral injuries were identified during endoscopic realignment: 12 complete urethral disruptions, 4 incomplete disruptions, 3 unable to determine. Mean time from injury to endoscopic realignment was 2 days (range 0–7 days). Mean duration of urethral catheterization following endoscopic realignment was 53 days (range 12–87 days). Fourteen of 19 patients failed initial endoscopic realignment. One patient was lost to follow up. Mean time to identification of failure following initial urethral catheter removal was 79 days (range 0–288 days). The following interventions were performed among the endoscopic realignment failures: posterior urethroplasty (11) and DVIU (3). Mean follow up for the remaining 4 patients considered to have undergone successful endoscopic realignment is 565 days (range 109–939 days). Findings identified at the time of endoscopic realignment in patients treated successfully with this technique included: complete disruption (2), 2cm dorsal bulbar laceration (1), vertical laceration at bladder neck (1). CONCLUSIONS Primary endoscopic urethral realignment following PFUDD results in high rates of symptomatic urethral stricture requiring further operative treatment. Close follow up after initial catheter removal is warranted. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e4 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Leddy Seattle, WA More articles by this author Hunter Wessells Seattle, WA More articles by this author Bryan Voelzke Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...