Distraction Defects Research Articles

Effect of Silodosin on bladder outlet during antegrade cystourethrogram in patients with pelvic fracture urethral distraction defect

Background: Pelvic fracture urethral distraction defect is a traumatic injury to the male urethra that affects the region between the bulbar urethra and the prostatic apex. Pelvic fracture causes urethral injury in about 10% of patients. Combined retrograde urethrogram and antegrade cystourethrogram is used to define the length of the urethral injury before planning the definitive surgery. But during antegrade cystourethrogram bladder outlet sometimes fails to open due to faulty technique, prolong suprapubic catheterization and increase sympathetic drive, leading to erroneous estimation of the length of urethral injury. To overcome this problem Silodosin used in this study, which is a highly uroselective and rapid-acting α-adrenoreceptor antagonist in comparison to other α-adrenoreceptor antagonists available in the market. The uroselectivity of Silodosin helps in maximizing the effect by opening the bladder outlet and limiting the adverse effect on the cardiovascular system.The objective of the study was to assess the effectiveness of Silodosin in opening bladder outlet in patients with pelvic fracture urethral distraction defect on antegrade cystourethrogram. Methods: This is a Quasi-experimental study that was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University. In this study, 35 Patients with pelvic fracture urethral distraction defect with suprapubic catheter in situ who failed to open the bladder outlet on initial antegrade cystourethrogram were included. Urine culture and sensitivity report is confirmed negative. All participants were received a single dose of Silodosin capsule 3 hours before the antegrade cystourethrogram. Retrograde urethrogram was performed. After 3 hours bladder was filled with diluted contrast through the indwelling suprapubic catheter under sterile conditions according to bladder capacity. When the participants were felt the normal desire to void, bladder filling was stopped and voiding command was given and x-ray films were taken. Then the x-ray films were reviewed and findings were noted about the opening of the bladder outlet and visualization of the posterior urethra. Any complications during the procedure were observed and noted. After confirming hemodynamic stability, patients were advised to go home and continue the prescribed antibiotic for 5 days. Results: Thirty-five men were evaluated during this study period. The mean ages of the patients were 39.9±10.4 years. All patients had a suprapubic catheter in situ and the mean duration of the suprapubic catheter was 3.8 ± 1.5 months. On average 363±87.3 ml of diluted contrast were introduced to initiate voiding reflex. Thirty-two patients out of the 35 patients (91.4%) were able to achieve the satisfactory opening of the bladder outlet (95% confidence interval 82.11- 100%), while 3 patients (8.6%) failed to open the bladder outlet. No patient developed postural hypotension after single dose of Silodosin. Two patients were reported post procedure (combined retrograde urethrogram and antegrade cystourethrogram) fever, which needed another 5 days antibiotic treatment. Conclusion: Single dose of Silodosin before antegrade cystourethrogram conferred a statistically significant increase in opening the bladder outlet inpelvic fracture urethral distraction defectpatients. Bangladesh Crit Care J September 2024; 12 (2): 138-144

Can the parameters of penile duplex assessment predict the success of urethroplasty?

BackgroundThis work aimed to study the role of penile duplex in predicting the outcome of anastomotic urethroplasty.MethodsBetween March 2022 and February 2023, all patients presented with posterior urethral distraction defect (PUDD) underwent anastomotic end to end urethroplasty. Preoperative evaluation of sexual function was performed using international index of erectile function (IIEF-5) and penile doppler parameters (the response E1 to E5, peak systolic velocity (PSV), end diastolic velocity (EDV) and resistivity index (RI)). Each patient was, routinely, evaluated through 12 month-follow up using IIEF-5, penile doppler parameters, uroflowmetry for Qmax and pelvic ultrasound for postvoid residual urine (PVR). The procedure was considered successful if Qmax > 15 ml/s and PVR < 50 cc at the end of follow up. The correlation between the success rate of anastomotic urethroplasty and pre-operative penile Doppler parameters was the primary outcome.ResultsThirty patients with a mean age of 29.47 ± 9.79 years were evaluated. Twenty patients (66.7%) had previous orthopedic surgery. The stricture site was membranous in 6 patients (20.0%) and bubo-membranous in 24 (80.0%). The mean stricture length was 2.52 ± 0.98 cm. There was a statistically significant increase in mean end-diastolic velocity (P < 0.001) with a subsequent significant decrease in mean resistance index (P < 0.001). 14.3% of pre-operatively potent patients developed venous leakage (P < 0.001), while there was no change of arteriogenic or venogenic erectile dysfunction. In addition, of the patients who have arteriogenic erectile dysfunction, 37.5% did not require surgery, 25% had a urethrocystoscopy, and 37.5% required a repeat end to end urethroplasty. There is a significant association between pre-operative peak systolic velocity and the need for re-operation (P = 0.005).ConclusionPenile duplex may anticipate anastomotic urethroplasty efficacy in the case of PUDD.

Transperineal anastomotic urethroplasty with distal transection versus proximal transection: How to predict?

Abstract Objectives To evaluate the pubourethral stump angle (PUA) to determine the site of urethral transection during transperineal anastomotic urethroplasty (TAU). Patients and methods Patients diagnosed with pelvic fracture urethral distraction defect who underwent preoperative magnetic resonance (MR) urethrography and were treated with TAU between June 2019 and December 2021 were retrospectively reviewed. According to the site of urethral transection during TAU, patients were classified into proximal and distal groups receiving TAU with proximal and distal transection, respectively. The demographic and clinical data were recorded. The PUA was measured on sagittal T2-weighted MR urethrography. The relationship between the site of urethral transection and PUA was analyzed. Results Sixty-seven patients were included. Forty-one and 26 patients were included in the proximal and distal groups, respectively. Finally, the success rates in the proximal and distal groups were 95.1% and 92.3%, respectively. The PUAs were 123.7° ± 14.6° and 86.5° ± 9.8° (p = 0.005), respectively. The curves for the 2 groups intersected between 90° and 110°. The scribing effects at 90°, 100°, and 110° in the 2 groups were compared in detail. Compared with 90° and 110°, 100° had the highest sensitivity as the demarcation line. Conclusions In the treatment of pelvic fracture urethral distraction defect, the PUA on MR urethrography is an objective and valid parameter for evaluating the site of urethral transection during TAU. A PUA &gt;100° indicates that proximal transection should be preferentially attempted.

Retrospective analysis of urethral anastomosis with ancillary maneuvers and intraoperative biaxial defect measurements to achieve a tension free guidance system for redo PFUDD treatment

ObjectivesRedo surgery for pelvic fracture urethral distraction defects (PFUDDs) is still a challenge. the long urethral defect makes it difficult while the high tension increase the recurrence rate. Although certain ancillary maneuvers can relieve tension, there is no consensus or guidelines for the prediction/planning of the selection. In this study, we present our experience with developing an intraoperative guidance system to achieve tension-free urethral anastomosis.Patients and methodsA total of 91 recurrent PFUDD patients managed at our center between 2020 and 2022 were retrospectively analyzed. The patients underwent scar removing and urethral anastomosis. For the long defect and high-tension cases, 6 kinds of tension-relieving maneuvers were used respectively during the process of urethral anastomosis. Preoperative assessment of the urethrogram was done before surgery, while biaxial (vertical and horizontal) defect measurements were performed intraoperatively. The patients were followed-up for 12 months (8.9 ± 4.2), furthermore, recurrence and complications were analyzed.ResultsThe overall success rate was 86.81%. The mean defect in urethrogram was 2.9 ± 1.1 cm. 27 simple anastomosis was performed when the vertical plus horizontal defect was less than 2 cm with 11.11% recurrence. 24 cavernous septum splittings were performed when the horizontal defect was greater than 2 cm with 8.33% recurrence. 21 inferior pubectomies were performed when the horizontal defect was greater than 3 cm with 19.05% recurrence. 15 ancillary distal urethra manipulations (fully distal urethral mobilization, urethral suspension and corpus cavernosa folding) were performed when the vertical defect was 3 to 4 cm with 13.33 recurrence. 4 reroutings were performed when the vertical defect was greater than 4 cm with 25.00% recurrence.ConclusionsAncillary maneuvers are effective for reducing tension in redo urethral anastomosis. Measurement of divergent vertical and horizontal urethral defects could guide the selection of ancillary maneuvers. Combined tension-relieving maneuvers is recommended according to the defect direction and length to achieve a tension-free anastomosis.

End to End Anastomotic Urethroplasty in the Management of Posterior Urethral Distraction Defect

Posterior urethral distraction deficits are a difficult and complex clinical condition that necessitates specialized care in urological therapy. End-to-end anastomotic urethroplasty has emerged as a critical procedure for treating posterior urethral distraction abnormalities, providing a thorough and successful approach for restoring normal urethral function. Objective: To assess the outcome of end-to-end urethroplasty in posterior urethral distraction defects. Methods: This study was conducted at the departments of Urology, MTI LRH, and Peshawar from 1st November 2017 to 31st December 2021. It was a descriptive case-series study by design. Patients included were having blind urethral strictures. End to end urethroplasty was performed. Patients were followed for one year. Depending upon symptoms relief, uro-flowmetery studies, and radiographic findings at the end of one year, success was defined as good, fair, or poor. Results: The study included a total of 110 patients, with a majority being male (80%) and the remaining 20% being female. The mean age of the patients was 35 years, with the majority falling in the age group of 30-39 years (50.9%). Good outcomes were recorded in 79 patients (71.8%). 11 (10.0%) participants had poor outcomes. Conclusions: Urethroplasty is a gold standard treatment modality in terms of outcome for patients with posterior urethral distraction defects.

War-related urethral and penile injuries' management and short-term outcomes: Experience from war in Yemen

Abstract Objectives To investigate the mechanisms of injury, wound patterns, surgical management, and outcomes of urethral and penile injuries caused by firearms and explosives during the ongoing war in Yemen. Materials and methods The present prospective descriptive study included 46 patients who sustained penile and/or urethral injuries during the ongoing Yemeni war. The patients received primary surgical care in Yemen and were referred for definitive treatment in Egypt between October 2018 and October 2020. Patient demographics, cause of injury, site and severity of injury, and associated injuries were evaluated together with management outcomes. Results The median age was 28 years (range, 18–50 years); 27 patients (58.7%) had posterior urethral injuries, 11 (23.9%) of whom had posterior urethral distraction defect injuries, 5 (10.9%) had a posterior urethral distraction defect injuries associated with urethrorectal fistulas, and the remaining 11 patients developed posterior urethral strictures; 9 patients (19.6%) sustained anterior urethral injuries, and 10 (21.7%) had isolated penile tissue injuries. Injuries to the penis (90%) and anterior urethra (67%) were primarily due to improvised explosive devices, whereas injuries to the posterior urethra (85%) were mostly caused by firearms. During the posttreatment follow-up period (6–12 months), 4 patients (8.7%) developed recurrent urethral strictures. Conclusions Urethral injuries caused by firearms and improvised explosive devices showed a greater association with urethrorectal fistulas or penile tissue injuries than what is typically observed in our practice. Management of these injuries by highly experienced urologists enhances patient outcomes and minimizes future complications.

Магнитно-резонансная томография в диагностике стриктуры уретры.

Introduction. In order to improve the results of surgical treatment of urethral stricture in men, it is extremely important to accurately diagnose preoperative changes. From this point of view, it seems promising to use magnetic resonance imaging (MRI) in the urethral stricture diagnosis, the assessment of which is the subject of this literature review. Materials and methods. The review is based on articles published throughout history in scientific peer-reviewed journals included in the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Scopus (https://www.scopus.com/), Scientific Electronic Library eLibrary.ru (https://elibrary.ru/). The search was performed on the following keywords: «magnetic resonance imaging», «MRI», «urethral stricture», «urethral obliteration», «urethral stenosis», «urethral injury», «urethral distraction defect», «urethroplasty», «urethral reconstruction», «urethral surgery», «pelvic fracture». At the first stage, 308 sources were found, of which 23 articles were included in the review. Results. A total of 23 original studies were identified in which MRI was used for urethral stricture in men, of which 2 were Russian studies. Four studies evaluated only anterior urethral strictures, 10 studies evaluated posterior urethral strictures, and 9 studies – both anterior and posterior urethral strictures. These studies included 10 to 121 patients with urethral stricture (mean 42 patients). MRI generally provides more accurate information on the extent of the stricture, the nature of spongiofibrosis and other periurethral changes, the presence of concomitant pathology compared to traditional methods for diagnosing urethral stricture. Conclusions. MRI for urethral stricture provides additional information for treatment planning. However, given the high cost of the method and a small number of works, further research is needed to obtain sufficient grounds for the widespread clinical use of MRI in urethral stricture.

MRI in Preoperative Planning for the Repair of Pelvic Fracture Urethral Distraction Defects: A New Tool for Determining Reconstructive Options

Pelvic fracture urethral distraction defects are typically imaged with retrograde urethrogram and voiding cystourethrogram during the work up for delayed posterior urethroplasty following trauma. The imaging results often dictate the decision-making regarding treatment options. Magnetic resonance imaging can offer a more detailed picture of the defect and can aid in preoperative planning. We present the case of an individual who was deemed unrepairable by routine imaging, however, the MRI indicated that surgery was possible.

High rising flames: a sign of complex extraperitoneal bladder rupture.

Extraperitoneal bladder rupture is the most common type of bladder injury following pelvic trauma and is seen in 80-90% of cases. Generally, the contrast extravasation seen on computed tomography (CT) cystography is confined to the perivesical space, giving a characteristic flame-shaped appearance. Occasionally contrast extravasation can extend to the scrotum, thigh or anterior abdominal wall, depending on the extent of injury. Here we report an unusual CT cystogram finding of complex extraperitoneal bladder rupture with associated pelvic fracture urethral distraction defect, showing large-volume contrast extravasation extending beyond the perivesical space to the left perinephric region resembling high rising flames.

Transperineal Urethroplasty for Urethral Distraction Defects Caused by Pelvic Fracture

Purpose: We report the outcomes of transperineal urethroplasty in patients with pelvic fracture urethral distraction defects (PFUDDs) over the past 12 years. Materials and Methods: Patients who received transperineal anastomotic repair of PFUDDs from January 2007 to December 2019 were retrospectively analyzed, specifically focusing on demographic findings, pelvic fracture type, urethral distraction defect length (based on retrograde urethrography and cystography), previous treatments, and ancillary maneuvers during surgery. Simultaneously, differences in clinical factors between successful and failed cases were also analyzed. Results: A total of 36 patients were included, with a final success rate of 83%. The mean age was 40.4 years, whereas the mean urethral distraction defect length was 31.9 mm. Most patients (69%) presented with unstable pelvic fractures. Treatment before referral included endoscopic treatment and urethroplasty in 13 (36%) and 2 cases (6%), respectively. For difficult cases, ancillary procedures, which included corporeal splitting (61.1%) and inferior pubectomy (8.3%), were performed. The postoperative average peak flow rate was 14.9 mL/s in the success group. Age and urethral defect length differed significantly between the success and failure groups. Conclusions: Over the past 12 years, transperineal urethral reconstruction demonstrated a success rate of 83% in 36 patients with PFUDD. Age and urethral defect length were identified as the two main factors affecting surgical prognosis.

Pelvic Fracture Urethral Distraction Defects in Preschool Boys: How to Recognize and Manage?

ObjectiveTo share the cases of pelvic fracture urethral distraction defect (PFUDD) in preschool boys and evaluate the transperineal anastomotic urethroplasty strategy for the treatment of these cases. Materials and MethodsBetween January 2010 and May 2021, 8 preschool boys (<6 years) with PFUDD underwent the transperineal anastomotic urethroplasty in our center were retrospectively reviewed. Etiology was traumatic pelvic fracture in all boys. The type of trauma included: fall injury in 1 and vehicle crush injury in 7. Urethroplasty was performed at least 3 months after initial trauma or the last failed intervention. One of them suffered from PFUDD associated with urethrorectal fistula received urethroplasty combined with fistula repair. A successful urethroplasty was defined as restoring the patency and continuity of urethra and no further interventions were needed. ResultsFollow-up was obtained in all the 8 preschool boys for 3-135 (median: 65) months. The average age was 4.1 years old (range 1-5). After operation, the final success rate was 100%. Neither stenosis recurrence nor urinary fistulas were reported during follow-up. Of the 8 boys, 1 developed urinary incontinence, only occurring after high-intensity exercise such as running. Potency state could not be evaluated for all boys due to the young age. One boy reported having normal morning erection after a follow-up of 135 months. ConclusionPFUDD in preschool boys is a challenge for both the urologist and parent. Our study preliminarily confirmed that the progressive anastomotic urethroplasty strategy can ensure a high success rate.

Transperineal anastomotic urethroplasty for the treatment of pelvic fracture urethral distraction defects: a progressive surgical strategy.

The aim was to reduce the difficulty of transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) and make it easy to master through an effective strategy. Between January 2010 and December 2019, 1637 patients with PFUDDs were treated by transperineal anastomotic urethroplasty. The surgical strategy we used was the progressive transperineal anastomotic urethroplasty. First, after full mobilization of the distal bulbomembranous urethra, the stenotic urethra was transected directly at the proximal margin of the stenotic urethra to expose the proximal disrupted urethral end. Second, if the urethral stenosis location of some complicated cases was too deep to fully mobilize, the position of urethral transection was selected at the distal margin of the stenotic urethra. Then, the distal and proximal disrupted urethras were then trimmed and anastomosed without tension. A successful urethroplasty was defined as reestablishment of a uniform urethral caliber and no further interventions were needed. Follow-up was obtained in 1475 patients. The success rate was 92.4% (1363/1475). Among the 112 failed patients, 10 patients received endoscopic urethrotomy, 99 underwent a secondary or third anastomotic urethroplasty and 3 successfully treated with perineal skin flap urethroplasty. After final successful urethroplasty, 125 patients (8.5%) had different degrees of urinary incontinence and 15 (1.6%) developed de novo erectile dysfunction (1.6%). The progressive transperineal anastomotic urethroplasty strategy was effective for treating PFUDD cases, improving surgical efficacy and reducing complications. It may contribute to standardizing the transperineal anastomotic urethroplasty and making it easy to master.

P1132 - Assessing the value of a novel MRI protocol in patients undergoing posterior urethroplasty for Pelvic Fracture Urethral Distraction Defect (PFUDD)

P1132 - Assessing the value of a novel MRI protocol in patients undergoing posterior urethroplasty for Pelvic Fracture Urethral Distraction Defect (PFUDD)

Role of tadalafil in enhancing visualization of posterior urethra prior to combined voiding cystourethrogram and retrograde urethrogram: a retrospective analysis.

To show utility of tadalafil in enhancing visualization of posterior urethra in patients with urethral stricture. We retrospectively reviewed the records of adults male who failed to delineate the posterior urethra while undergoing combined voiding cystourethrogram and retrograde urethrogram (VCUG and RUG), as a part of preoperative assessment of stricture length and location before urethral reconstruction. The study was repeated 24 h later after a single dose of tadalafil 20 mg was administrated 2 h before the procedure (Tadalafil group). A control group who did not receive any medication was used for comparison (control group). This study was carried out in between March 2016 and August 2019. Thirty patients were included in the tadalafil group and equal number of patients was used as control group for comparison. The etiologies of strictures were pelvic fracture urethral distraction defect (39 patients), bulbar stricture with complete obliteration (15 patients) and post catheterization (6 patients). Success rate of opening bladder outlet on initiation of voiding was 90% in tadalafil group and 40% in the control group (P = 0.0004). None of the men reported any serious adverse events after oral administration of the drug. Almost all AEs were mild and well-tolerated. Tadalafil effectively relaxes the bladder neck and the posterior urethra prior to combined VCUG and RUG in urethral stricture patients. Tadalafil was safe with no serious adverse effects when administered prior to performing the test. This prevents the patients from undergoing further invasive or expensive diagnostic techniques, moreover, tadalafil assisted in preoperative surgical preparation and patient's counseling.

Sexual function following pelvic fracture urethral injury and posterior urethroplasty.

BackgroundTo evaluate erectile and sexual function after pelvic fracture urethral injury (PFUI) by performing a retrospective review of a large multi-center database. We hypothesized that most men will have erectile dysfunction (ED) and poor sexual function following PFUI, which will remain after posterior urethroplasty.MethodsUsing the Trauma and Urologic Reconstructive Networks of Surgeons (TURNS) database, we identified PFUI patients undergoing posterior urethroplasty. We excluded patients with incomplete demographic, surgical and/or questionnaire data. Sexual Health Inventory of Men (SHIM), Male Sexual Health Questionnaire (MSHQ), and subjective changes in penile curvature were collected before urethroplasty surgery and at follow-up. We performed descriptive statistics for erectile and ejaculatory function using STATA v12.ResultsWe identified 92 men meeting inclusion criteria; median age was 41.7 years and BMI was 26.5. The mechanism of injury was blunt in all patients, and average distraction defect length was 2.3 cm (SD 1.0 cm). In the 38 patients who completed both pre and post-operative SHIM questionnaires, the mean SHIM score was 10.5 (SD 7.0), with 63% having severe ED (SHIM <12). The median follow-up was 5.6 months and the mean post-operative SHIM was 9.3 (SD 6.5), with 68% having severe ED. The mean change in SHIM score was −1.18 (SD 6.29) with 6 (16%) patients reporting de novo ED (≥5 point decrease in score). Of the men with pre-operative MSHQ data, 46/74 (62.1%) had difficulty with ejaculation, 25/35 (71%) had change in penile length, and 6/33 (18%) reported penile curvature. In men with post-operative MSHQ, 19/44 (43%) expressed difficulty with ejaculation, 23/32 (72%) had change in penile length, and 9/33 (27%) reported penile curvature.ConclusionsThere is a high rate of severe ED, both following PFUI and remaining after posterior urethroplasty. Additionally, rates of ejaculatory difficulty and patient perceived changes in penile length and curvature underscore the complex nature of the impact of these injuries on sexual function beyond simple erectile function.

Use of pedicled dartos flap wrap around technique in elaborarted perineal repair of complex pelvic fracture urethral distraction defect

Objectives: To describe the use of a pedicled dartos flap between the pubic bone and bulbar urethra after elaborate perineal urethroplasty in complex pelvic fracture urethral distraction defect. This is to prevent the risk of entrapment of the anastomotic area within a fibrous scar and hence prevent the risk of urethral stricture recurrence. Our objective is also to theorise the entity of bulbar urethral entrapment to describe the trapping of the bulbar urethra by fibrosis after extensive bone resection in complex cases of pelvic fracture urethral distraction defect. Methods: Ten patients with complex pelvic fracture urethral distraction defect underwent perineal urethroplasty at our institution from 2017 to 2019. Urethroplasty was done using the elaborated perineal approach in the standard fashion. Pedicled fibrofatty tissue along with dartos from the scrotum was used to separate the site of urethral anastomosis from the bare pubic bone and fill the dead space. Results: All patients are asymptomatic with no stricture recurrence in follow-up. Conclusions: Vascularised pedicle flap should become an important tenant in the elaborated perineal repair of complex pelvic fracture urethral distraction defect. It provides an ideal option in this scenario by decreasing the risk of urethral stricture recurrence without adding morbidity and minimum extra operative time. Level of evidence: Not applicable.

Transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects: The outcomes of surgical management.

Currently, transperineal anastomotic urethroplasty approach is the reference standard in the surgical reconstruction of pelvic fracture urethral distraction defects. The approach is suitable for all but the most complex cases which might require abdominoperineal approach. We reviewed our recent experience with transperineal anastomotic urethroplasty with respect to success rate and complications. This was a retrospective descriptive study carried out at Jos University Teaching Hospital from March 2015 to March 2018. The case notes of male patients who had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defects within the study period were retrieved. Patients' demographics, cause and nature of pelvic fracture urethral distraction defects, the success rate, and complications were collected and subjected to statistical analysis using SPSS® version 22. Sixteen men with mean age of 29.6 ± 7.8 years had transperineal anastomotic urethroplasty for pelvic fracture urethral distraction defect (PFUDD) during the study period. The mean defect gap length was 4.5 cm (range, 2-7 cm). Out of the 16 patients, 6 (37.5%) had simple transperineal urethroplasty, while 10 (62.5%) underwent a more extensive transperineal urethroplasty. Four patients (25%) had inferior pubectomy. A total of 7 (43.8%) patients had erectile dysfunction (ED) before and after the urethroplasty. Five (31.3%) patients had ED before the urethroplasty 2 (12.5%) patients developed ED after the surgery. After mean follow-up duration of 2 years (range, 1-4 years), 12 (75%) patients had satisfactory urinary stream. The mean Qmax for the 16 patients was 16 ml/s (range, 0-35 ml/s). The 12 (75%) patients that had no complaints of LUTS, had Qmax ≥ 15 ml/s at mean follow-up duration of 2 years. Transperineal anastomotic urethroplasty for PFUDD is considered suitable technique for treatment of PFUDD with good surgical outcome.

Surgical Repair of Posterior Urethral Distraction Defects and its Outcome : Initial Experience in a Tertiary Level Hospital

Purpose: Management of posterior urethral distraction defects are challenging for urologists and need very careful and meticulous dissection for getting a good outcome. Dhaka medical college hospital is a tertiary referral hospital where we receive a lot of cases from different districts. The study was done to observe the outcome of anastomotic urethroplasty for posterior urethral distraction defects. Methods : This was a prospective experimental study. This study was done in a single unit of DMCH urology department by a single surgeon . Those who were suffering from posterior urethral distraction defects with suprapubic catheter in situ were included and underwent anastomotic urethroplasty from the period of January, 2018 to october, 2019. After proper evaluation and counseling all patients underwent perineal anastomotic urethroplasty under spinal anesthesia with 6-8 interrupted suture, using 4/0 vicryl. A 14 Fr Foley catheter was placed in urethral lumen and 16 Fr catheter in SPC site. A latex strip drain was placed for perineal wound. Drain was removed after 48 hours of operation . Patients were usually discharged in between 5th to 7th POD with definite follow up protocol and medications with supra pubic catheters (SPC) and per urethral catheters in situ. On 21 POD urethral catheter was removed. SPC was removed after 7 days if patient can void normally. 1st and 2nd follow up were done at the completion of 3rd and 6th month respectively. The prevalence of post-operative sexual disorders was investigated using the International Index of Erectile Function-5 (IIEF-5) questionnaire during follow-up. If the patient can able to void per urethra in a well manner and Qmax&gt;15 mL/s then repair was defined successful. Result : Success rate of perineal anastomotic urethroplasty for posterior urethral distraction defect was 83.33.%. 18 patients were included in the study. The mean age was 28.27 years. 17 patients were able to void successfully after surgical procedure but among those 2 patients had urinary flow rate &lt; 15 ml/sec and one patient didn’t able to void. 3 patients had developed wound infection, 3 patients developed erectile dysfunction. Conclusion : Perineal anastomotic urethroplasty is gold standard for treatment of posterior urethral distraction defects. Long term follow up is needed to give a opinion regarding the ultimate outcome of the surgical procedure and that have give a good idea for future management. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.193-198

Outcome of Laser Urethrotomy in Comparison with Optical Internal Urethrotomy in Recurrent Stricture Urethra Following Perineal Anastomotic Urethroplasty for PUDD

Objective: To compare the outcome of laser urethrotomy and optical internal urethrotomy(OIU) for the treatment of recurrent stricture urethra following perineal anastomotic urethroplasty for posterior urethral distraction defect. Materials and methods: The study was conducted in Dhaka Medical College Hospital from January 2013 to December 2014.Male patients presented with obstructed voiding symptoms following perineal anastomotic urethroplasty were evaluated by their history, physical findings and investigations (urinalysis, uroflowmetry, retrograde urethrogram and micturiting cystourethrogram ) &amp; primarily 64 patients are selected by purposive sampling. Patients are divieded again by random allocation into group A and group B and underwent for OIU and laser urethrotomy respectively. Results: Comparison was made to find out the better method between optical urethrotomy and laser urethrotomy. Overall per-operative complications (bleeding, extravasations of irrigating fluid, false passage and broken knife) in the former group were 31.3% compared to none in the latter group. Post-operative complications like bleeding, haematoma, penile oedema and erectile dysfunction were found only in Group-A (p=0.002). The mean duration of postoperative catheterization and average hospital stay were observed to be much higher in Group-A than that in Group-B (p=0.000008; p=0.0006). Comparison of final outcome (development of stricture) between groups at 1 year of evaluation in Group-A and Group-B was not significant (p= 0.320). Conclusion: Laser urethrotomy is better than optical urethrotmy in regards of peroperative and post-operative complications. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.181-187

Outcome of Anastomotic Urethroplasty in Posterior Urethral Distraction Defect With or Without Mucosal Fixation- a Randomized Clinical Trial

Introduction: Anastomotic urethroplasty is the treatment of choice for posterior urethral distraction defect. To notice the high failure rate of anastomotic urethroplasty, several peri-operative factors are identified. Among the per-operative factors, mucosal fixation of the both urethral ends is one of the outcome influencing factor that is recently identified. So, this randomized clinical trial has been designed to compare the outcome of anastomotic urethroplasty in posterior urethral distraction defects with or without mucosal fixation. Objective: To compare the outcome of anastomotic urethroplasty of PUDD patient groups with or without mucosal fixation in terms of post-operative IPSS, maximum urine flow rate and post void residual urine. Patients and Methods: The present study was conducted in the department of Urology, BSMMU between January’16 - November’17. Posterior urethral distraction defects with length of gap between two urethral segments upto 3 cm. were included in the study. The patients in whom anastomotic urethroplasty were done with mucosal fixation were enrolled as study group(n=21) and patients in whom anastomotic urethroplasty were done without mucosal fixation were included as control group(n=21). All the patients were followed upto 6 months of anstomotic urethroplasty and failure of anastomotic urethroplasty (by RGU and MCU), PVR and maximum urine flow rate (Qmax) in between two groups were compared. Result: The failure rate was found significantly higher in control group than in the study group (p=0.043). The control group showed highly significant (0.001) increase in postoperative PVR than the study group and the study group showed significant (0.007) increase in post operative maximum urine flow rate than the control group as was assumed in the hypothesis. Conclusion: In conclusion, it can be said that anastomotic urethroplasty with mucosal fixation is a better option than anstomotic urethroplasty without mucosal fixation. But multicentric trial is needed to further comment. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.31-34