PD44-07 PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD) WITH ASSOCIATED RECTAL INJURY: A REVIEW OF ACUTE AND DEFINITIVE UROLOGIC MANAGEMENT WITH LONG TERM OUTCOMES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2016PD44-07 PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD) WITH ASSOCIATED RECTAL INJURY: A REVIEW OF ACUTE AND DEFINITIVE UROLOGIC MANAGEMENT WITH LONG TERM OUTCOMES Brian Montgomery and Douglas Husmann Brian MontgomeryBrian Montgomery More articles by this author and Douglas HusmannDouglas Husmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES PFUDD with concurrent rectal injuries are rarely reported, occurring in 3% of patients having a PFUDD. The purpose of this study is to describe the management and long term sequela of a series of patients with this complex of injuries. METHODS We retrospectively reviewed all patients presenting with a PFUDD to our institution from 1990 to 2015. All charts were reviewed to determine the presence of concurrent rectal and bladder injuries, the development of complications, and the initial and definitive treatments. RESULTS A total of 17 patients had PFUDD and concurrent rectal injuries. Median follow-up after definitive urologic reconstruction is 3 years. Concurrent bladder neck lacerations existed in 52% (9/17) and sacral spinal cord injuries in 12% (2/17). In the 9 patients that had concurrent bladder neck lacerations, 44% (4/9) initially underwent primary repair of both the bladder neck and urethral injury; two developed chronic incontinence (one eventually managed by cystectomy and continent diversion), one has stress urinary incontinence, and one restrictured the urethra (managed by continent stoma). In the 33% (3/9) managed with initial closure of the bladder neck and SP tube diversion; two underwent creation of a continent stoma and one preferred long term management with a SP tube. In the 23% (2/9) managed with repair of bladder neck and SP tube; both developed chronic pelvic abscess formation, eventually managed by cystectomy and colon conduit urinary diversion. In the 8 patients without a bladder neck laceration, seven were managed by SP tube alone and one with SP tube with urethral realignment. All developed an obliterative urethral stricture. 75% (6/8) underwent urethral reconstruction and 25% (2/8) chose long term management by a SP tube. In the 6 patients undergoing reconstruction, 50% (3/6) developed complications. One has chronic incontinence and underwent bladder neck closure and SP tube placement, one has stress incontinence, and one redeveloped a stricture managed by urethrotomy. In essence, four patients are continent and without evidence of recurrent stricture. Based on SHIM scores, 88% (15/17) have severe erectile dysfunction and 12% (2/17) have mild ED. CONCLUSIONS PFUDD associated with a rectal injury is frequently associated with concurrent bladder neck lacerations and difficulty with regaining continence. Following definitive reconstruction, normal voiding and complete urinary continence developed in only 24% (4/17). Normal erectile capability was present in only 12% (2/17). © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1000 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brian Montgomery More articles by this author Douglas Husmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...