V12-01 LAPAROSCOPIC OMENTOPLASTY TO SUPPORT ANASTOMOTIC URETHROPLASTY IN COMPLEX AND REDO PELVIC FRACTURE URETHRAL DEFECT PATIENTS

Abstract

You have accessJournal of UrologyReconstruction1 Apr 2015V12-01 LAPAROSCOPIC OMENTOPLASTY TO SUPPORT ANASTOMOTIC URETHROPLASTY IN COMPLEX AND REDO PELVIC FRACTURE URETHRAL DEFECT PATIENTS Sanjay B. Kulkarni, Walid Shahrour, Pankaj Joshi, Craig Hunter, Sandesh Surana, and Guido Barbagli Sanjay B. KulkarniSanjay B. Kulkarni More articles by this author , Walid ShahrourWalid Shahrour More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Craig HunterCraig Hunter More articles by this author , Sandesh SuranaSandesh Surana More articles by this author , and Guido BarbagliGuido Barbagli More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2771AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Complex and redo urethroplasties can be challenging in patients with Pelvic Fracture Urethral Defects (PFUD). The wrapping of the anastomosis with omentum can help in filling the dead space created by the inferior pubectomy and scar excision, absorption of serous exudates, maintain suppleness around anastomosis, and decrease the rate of fistula formation. In this study we aim to report the technique, feasibility, safety and results of laparoscopic omentoplasty to support perineal anastomosis in complex and redo PFUD patients. METHODS We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with complex and redo PFUD at a single center in Pune, India between January 2012 and February 2013. Patients with PFUD occurring after pelvic fracture urethral injury (PFUI) were included in the study, while anterior urethral strictures were excluded. The primary study outcome was the success rate of the surgical technique and the secondary outcome was to evaluate feasibility and safety of the procedure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done. RESULTS Fifteen male patients with a median age of 19 years were included in the study. Seven patients were adolescents (12-18 years) and 8 (53.3%) adults (19-49 years). All patients underwent elaborated bulbo-membranous anastomosis using a perineal approach with inferior pubectomy combined with laparoscopic mobilization of the omentum into the perineum to envelope the anastomosis and to fill the perineal dead space. Of 15 patients 14 (93.3%) were successful and 1 (6.6%) failed. One adolescent boy 14 years old developed a recurrent stricture 2 months after the procedure and was managed using internal urethrotomy. Median follow up was 18 months (range 13 to 24). CONCLUSIONS In an era of minimally invasive surgery, this new laparoscopic omentoplasty technique can provide support to the anastomotic perineal urethroplasty in complex and redo PFUD patients © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e977 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjay B. Kulkarni More articles by this author Walid Shahrour More articles by this author Pankaj Joshi More articles by this author Craig Hunter More articles by this author Sandesh Surana More articles by this author Guido Barbagli More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...