PD22-03 HOW DIMINISHED CAVERNOSAL ARTERIAL BLOOD FLOW AFFECTS THE SUCCESS OF ANASTAMOTIC URETHROPLASTY AFTER PELVIC FRACTURE URETHRAL INJURY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) III1 Apr 2015PD22-03 HOW DIMINISHED CAVERNOSAL ARTERIAL BLOOD FLOW AFFECTS THE SUCCESS OF ANASTAMOTIC URETHROPLASTY AFTER PELVIC FRACTURE URETHRAL INJURY Craig Hunter, Walid Shahrour, Pankaj Joshi, Sandesh Surana, Vikram shah Batra, and Sanjay Kulkarni Craig HunterCraig Hunter More articles by this author , Walid ShahrourWalid Shahrour More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Sandesh SuranaSandesh Surana More articles by this author , Vikram shah BatraVikram shah Batra More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1445AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The vascular supply to the urethra is of paramount importance to urethra. Pelvic Fracture Urethral Injury (PFUI) is often accompanied by vascular injury. For patients with erectile dysfunction and PFUI, it has been previously recommended to undergo a preoperative penile Doppler to investigate penile blood flow. In cases when arterial insufficiency (less than 25 ml/sec) is found, it has been recommended to undergo penile revascularization prior to urethroplasty. The aim of our study was to evaluate the success of urethroplasty in patients with diminished cavernosal arterial blood flow. We hypothesized that decreased cavernosal flow led to increase failure rates of anastomotic urethroplasty after PFUI. METHODS This is a retrospective review from Jan 2013 to September 2013 of those patients who underwent repair of pelvic fracture urethral defect and whom penile Doppler was available. All patients with pelvic fracture planning to undergo anastamotic urethroplasty obtain a penile Doppler, irrespective of their stated subjective erection abililty. All penile Doppler studies were performed by an outside imaging center, and reports were reviewed. Locally and worldwide, the radiologist is usually performing the study for erectile dysfuction, and as such the report is limited to the cavernosal artery; rarely is the flow of the dorsal penile artery flow reported. All patients underwent progressive perineal anastamotic urethroplasty. Failure was described as need for repeat urethroplasty, visual internal urethrotomy, urethal dilation, or need for indefinite urinary catheter. RESULTS From January 2013 to September 2013, 103 Pelvic fracture urethral defects were repaired at our institution. 65 patients with follow up and penile Doppler were available for review. Mean age of patient was 26 years (range 17 to 52), and mean follow up of 16 months (range 12 to 21). Among the 65 patients, 14 (25%) had a documented cavernosal artery flow of less than 25 ml/sec bilaterally. Of those 16 patients with documented poor flow, 12 (75%) had successful urethroplasty. 39 of the 49 (80%) patients with adequate flow had successful urethroplasty. CONCLUSIONS Diminished cavernosal artery flow rates are not predictive of success or failure in PFUI repair. Patients with severe cavernosal artery insufficiency have adequate successful anastamotic urethroplasty after PFUI. A prospective evaluation of the Dorsal Penile Artery may prove to have a more significant correlation to success after PFUI. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e477 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Craig Hunter More articles by this author Walid Shahrour More articles by this author Pankaj Joshi More articles by this author Sandesh Surana More articles by this author Vikram shah Batra More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...