Abstract
BackgroundThe optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Conventionally, suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute management of blunt straddle injuries to bulbar urethra is controversial. We report our clinical experience and outcomes with EER for patients with straddle injury to the bulbar urethra in a level one trauma center.MethodsWe retrospectively reviewed 44 male patients who were transferred to our trauma center between January 2013 and January 2019 for acute management of blunt straddle injury to the perineum leading to bulbar urethra injuries. We reviewed the medical records of those patients to identify demographics, emergency management and clinical outcomes.ResultsThe most common injury mechanism was falling onto the perineum (n = 27, 61.4%), followed by motorcycle accident (n = 11, 25.0%) and bicycle accident (n = 6, 13.6%). Of the 44 patients, 14 (31.8%) were partial bulbar urethral ruptures and 30 (68.2%) were complete bulbar urethral ruptures. 31 (70.5%) patients successfully underwent EER and 13 (29.5%) patients failed attempted EER. the difference between successful EER attempts and failed ones in term of injured urethral mucosa integrity was statistically significant (P = 0.035, OR 8.667,95% CI: 0.998–75.235). In patients who underwent successful EER, urethral stricture occurred after catheter removal at a median of 8 (1–28) months in 24 (77.4%) patients and the mean stricture length was 1.8 ± 0.8 (0.5–3.0), which was not statistically significant when compared with those who failed EER (P = 0.103). Overall, 21 out of 24 (87.5%) patients with strictures after EER were successfully managed by urethroplasty.ConclusionsAlthough achieving a successful EER attempt is relatively easy for most patients with straddle injury to the bulbar urethra, it does not improve urethral healing significantly. Most patients with stricture formation after EER have to be cured with urethroplasty.
Highlights
The optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question
Patients After obtaining permission from our institutional ethical committee, we retrospectively reviewed 54 male patients who were transferred to our trauma center between January 2013 and January 2019 with blunt straddle injury to the perineum and acutely managed by early endoscopic realignment (EER) at Beijing Jishuitan hospital, which is the trauma center of Beijing and a specialized center for urethral reconstruction
Those patients who failed attempted EER were maintained on suprapubic catheterization (SPC) drainage and underwent delayed urethroplasty at 3 months later
Summary
The optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute management of blunt straddle injuries to bulbar urethra is controversial. We report our clinical experience and outcomes with EER for patients with straddle injury to the bulbar urethra in a level one trauma center. The optimal acute management of patients with blunt straddle injury remains in question [2,3,4]. Suprapubic diversion with delayed urethroplasty can always be considered for patients with anterior urethral injuries, if necessary.
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