Pelvic Fracture Posterior Urethral Distraction Defect (PUDD): Is Multislice CT Voiding Cystourethrography Capable of Predicating the Surgical Approach

Abstract

Purpose Blunt fracture pelvis is associated with PUDD in 10% of cases. The choice of surgical approach depends on adequate determination of the exact length of the distraction defect and the anatomy of the bulbar as well as the prostatic urethra in relation to bony pelvis. Conventional combined cystourethrogram is not reliable in predicting the proper surgical approach. Hence, we investigated the role of multislice CT cystourethrogram in predicting accurately the surgical approach. Material and Methods In the period between January 2007 to October 2009, 16 patients divided into two groups, group I includes 9 children and adolescents with mean age of 15 years (5-18) and group II includes 7 patients with mean age of 31.5 Years (20-55). All have PUDD following fracture pelvis. For the 2 groups both conventional combined cystourethrogram and multislice CT cystourethrogram were performed. Results Two patients underwent endoscopic visual urethrotomy and 14 patients underwent anastomotic urethroplasty of these14 patients, 8 patients underwent perineal urethroplasty, 5 patients underwent perineal urethroplasty with inferior pubectomy, 1 patient underwent transpubic urethroplasty. The approach of surgery was predicted preoperatively depending on CT findings which were not predictable by conventional combined cystourethrogram. Conclusions Multislice CT cystourethrogram delineates the anatomy of the PUDD, giving adequate information about the relation between the distraction defect and the bony pelvis with adequate determination of the length of the defect which makes choice of the surgical approach predictable.