Abstract
Objective. To evaluate the long-term results of transpubic urethroplasty for pelvic fracture urethral distraction defects. Patients and Methods. Sixteen patients who had undergone transpubic urethroplasty for posttraumatic complex posterior urethral disruptions between 2007 and 2013 were analyzed retrospectively and prospectively. Patients were followed up for a mean (range) of 24 (6–60) months by history, urinary flow rate estimate, retrograde urethrography, and voiding cystourethrography. Results. The mean age of the patients was 30.4 years. The estimated radiographic stricture length before surgery was 4.3 cm. Transpubic urethroplasty was successful in 14 out of 16 patients. Postoperative complications were recurrent stricture (12.5%), urethrocutaneous fistula (12.5%), incontinence (31.25%), impotence (25%), and wound infection (18.75%). Failed repairs were successfully managed endoscopically in one patient and by perineal anastomotic repair in the other, giving a final success rate of 100%. Five out of 16 patients were incontinent of which 3 of them resolved and 2 had permanent incontinence. Impotence was seen in 4 out of 16 patients. There were no reported complications of pubectomy in any of our patients. Conclusions. Though considered obsolete now, transpubic urethroplasty for complex posterior urethral disruptions is still a viable alternative with excellent results and minimal morbidity.
Highlights
The outlook for the patient with a pelvic fracture urethral distraction defects has improved almost beyond recognition in the last decade as a result of the development of variety of anastomotic techniques and novel approaches for urethral reconstruction
The surgical records at our institute were reviewed to identify patients who had had a transpubic urethroplasty for posttraumatic complex posterior urethral disruption between 2007 and 2013
All patients had urethral disruptions associated with trauma, caused by a motor vehicle in 13 (82%) and a fall from height in 3 (18%); the trauma was associated with a pelvic fracture in all patients with Tile’s type B being the most common
Summary
The outlook for the patient with a pelvic fracture urethral distraction defects has improved almost beyond recognition in the last decade as a result of the development of variety of anastomotic techniques and novel approaches for urethral reconstruction. Complex posterior urethral disruptions continue to represent a genuine challenge and they pose one of the most difficult management problems in urology, which represents 5% of all pelvic fracture urethral distraction defects. It is characterized by a stricture gap exceeding 3 cm, previous failed repair, associated perineal fistulas, rectourethral fistulas, periurethral cavities, false passages, or an open bladder neck [3, 4]. Over a 6-year period, we have managed sixteen cases of traumatic complex posterior urethral disruptions with a preliminary suprapubic cystostomy and delayed urethroplasty by a transpubic approach
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