Redo Urethroplasty Research Articles

Vessel-sparing Excision and Primary Anastomosis.

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

Analysis of anastomotic urethroplasty for pelvic fracture urethral distraction defect: Decadal experience from a high-volume tertiary care center.

Context:Pelvic fracture urethral distraction defect (PFUDD) may be challenging for the treating urologist. Anastomotic urethroplasty is the established surgical procedure for the treatment of PFUDD. Few studies in literature focus purely on PFUDD, and majority of the studies include anterior urethral stricture as well. The period of these studies is relatively short. We conducted a retrospective analysis of patients who underwent primary or redo anastomotic urethroplasty for PFUDD over a period of 12 years at a tertiary care center in northern India.Aims:The aim is to study anastomotic urethroplasty for pelvic fracture urethral distraction defect with regard to long-term success rate and complications.Settings and Design:This was a retrospective study. Subjects andMethods:This retrospective study was conducted in the Department of Urology, King George's Medical University, Lucknow, India, from August 2004 to July 2016. All patients who underwent progressive perineal anastomotic repair of PFUDD were included in this study. Demographic findings, type of pelvic fracture, length of distraction defect as per retrograde urethrography (RUG) and micturating cystourethrography, any history of erectile dysfunction in the preoperative or postoperative phase, and urinary incontinence in postoperative phase were analyzed. Decision regarding catheter removal was taken after pericatheter RUG at 4 weeks. Follow-up was done at 3 and 6 months in postoperative period.Results:A total of 226 anastomotic repairs were done in 221 patients. Of the 221 patients, 51 (23%) were redo urethroplasty. The mean age of patients was 27.6 years. The mean length of distraction defect was 2.7 cm. The mean duration of hospital stay was 6 days. Primary urethroplasty was successful in 163 (93.14%) of 175 patients and redo urethroplasty in 44 (86.27%) of 51 patients. Out of 165 patients, 18 (10.9%) patients reported occasional incontinence while 6 (3.63%) patients reported mild incontinence.Conclusions:Anastomotic urethroplasty is the definitive procedure for PFUDD. Our success rate for primary deferred anastomotic urethroplasty is 93.14% and for redo anastomotic urethroplasty is 86.27%.

Contemporary outcomes of hypospadias retrieval surgery in adults.

To describe the surgical approach and outcomes in the treatment of adult patients with complications of childhood hypospadias surgery, as such patients present a significant reconstructive challenge due to the combination of anatomical and cosmetic deformity, which often results in major functional and psychosexual sequelae. We analysed prospectively collected data on 79 adults with complications of childhood hypospadias surgery, who were operated on between 2004 and 2016. Of the 79 patients, 48 underwent a two-stage urethroplasty using a buccal mucosa graft, and 31 underwent a one-stage distal urethroplasty. Patients were followed up using flexible cystoscopy (every 6-9 months). The mean (range) follow-up was 48 (12-96) months. Of the 48 patients who underwent a two-stage repair, eight (16%) needed a revision of the first-stage graft. In total, nine of the 48 patients (16%) developed fistula requiring closure after the second stage; all but one was closed successfully on the first attempt, whilst one required two attempts before closure. Only two of the 48 patients that underwent a two-stage procedure required a re-do urethroplasty within 3 years. Of the 31 patients who underwent a one-stage repair, six (19%) needed fistula closure, all of which were successful. No patient required a further urethroplasty during follow-up. Despite the significant surgical challenges found in this patient group, excellent long-term functional outcomes can be achieved. As expected there is a need for additional intervention, either for revision of the first stage or to close fistulae and less commonly for further reconstruction for stricture recurrence.

Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Outcome Analysis of Redo Urethroplasty for Large and Multiple Urethrocutaneous Fistula

Long term outcomes of re-do urethroplasty: Outcome evaluation through flexible cystoscopy

Long term outcomes of re-do urethroplasty: Outcome evaluation through flexible cystoscopy

Redo urethroplasty after multiple failure of surgical procedures for complex pelvic fracture urethral distraction defect

Urethral reconstruction due to the failure of a previous surgical procedure poses a challenge. Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications such as recurrent stricture, erectile dysfunction, and incontinence. In this article, we report our experience using redo posterior end-to-end anastomotic urethroplasty for a case with recurrent stricture after the failure of previous surgical procedures that included a urethral stent insertion. A 28-year-old man with suprapubic cystostomy had suffered from urinary retention for 4 years since his last surgery. He had a history of an accident 8 years ago, with stable pelvic fracture, mild head injury, and urinary retention. This patient had already undergone cystostomy and primary endoscopic realignment, end-to-end anastomosis, buccal mucosal graft urethroplasty, and urethral stent insertion. All procedures had failed. We then did a micturition cystourethrography-retrograde urethrography (MCU-RGU) and showed total membranoprostatic stricture with a Memokath urethral stent. In the antegrade panendoscopic evaluation, we found multiple stones inside his urethral stent, and retrograde panendoscopic evaluation showed the total posterior urethral obstruction. Lithotripsy and Memokath urethral stent removal were done in the first stage. A week later, he underwent a redo posterior end-to-end anastomotic urethroplasty and insertion of a 14 Fr silicone catheter. This patient had spontaneous micturition; uroflowmetry examination showed a Qmax of 21.4 ml/s after urethral catheter removal, and the MCU-RGU result was patent urethral caliber. Proper anastomotic urethroplasty remains essential in the management of PFUDD, even in previously failed urethral repairs. Buccal mucosal graft urethroplasty and urethral stents have no place in the definitive procedure in posterior urethral stricture due to its complications.

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

ObjectiveTo report the surgical details and results of our technique of buccal mucosal graft (BMG) urethroplasty for panurethral stricture, as many studies have reported repair of panurethral stricture by single-stage BMG urethroplasty by placing buccal mucosa ventrally, dorsally or dorsolaterally. Patients and methodsThis was an observational analysis of 38 patients with panurethral stricture treated by placing two BMGs, one as a ventral onlay in the proximal bulbar urethra and the other as a dorsal onlay in the distal bulbar and penile urethra. Success was defined as asymptomatic state with or without need for a postoperative single intervention such as dilatation or internal urethrotomy. ResultsThe 38 patients had a mean age of 44 years, with lichen sclerosus as the predominant cause of stricture. The ultimate success rate was 84.2% at the end of 3 months and 89.5% at the end of 1 year. Recurrent strictures appeared only in the failed cases during the follow-up period of 11 months. None of the patients needed redo urethroplasty during the follow-up period. ConclusionsA proximal ventral and distal dorsal onlay technique of BMG urethroplasty is an available alternative for repairing panurethral stricture. The technique described is simple and easily reproducible with encouraging results compared to other similar techniques.

Long-term Results of Ventral Penile Curvature Repair in Childhood

To assess the postpubertal outcome of ventral penile curvature repaired in infancy in terms of recurrence and aesthetics. Postpubertal patients treated for hypospadias and ventral penile curvature in infancy at a tertiary medical center were invited to undergo assessment of the quality of the repair. Findings were compared between patients with a straight penis after skin release and patients who required dorsal plication. The cohort included 27 patients of mean age 16.5 years who were reported with straight penis after surgery. Postpubertal curvature was found in 6 of 14 patients (43%) successfully treated by skin release and 10 of 13 patients (77%) who underwent dorsal plication (P = .087). Significant curvature (≥30 degrees) was found in 1 of 14 patients in the skin-release group and 4 of 13 in the dorsal plication group (P = .16). Rates of redo urethroplasty were 2 of 14 (14%) and 5 of 10 (50%), respectively. Patient satisfaction with the appearance of the penis did not differ significantly. Ventral penile curvature repaired in infancy often recurs after puberty. The need for dorsal plication has a trend-level association with recurrence of penile curvature in puberty. It might also be related to the degree of postpubertal penile curvature and the need for redo urethroplasty. Procedure type does not affect patient satisfaction with the postpubertal appearance of the penis.

280 - Re-do urethroplasty after unsuccessful urethral reconstruction with buccal mucosa graft

280 - Re-do urethroplasty after unsuccessful urethral reconstruction with buccal mucosa graft

IS3-05 Modified tubularized incised plate repair for impeding fistula formation in re-do urethroplasty or hypospadias patients with thin urethral plates

IS3-05 Modified tubularized incised plate repair for impeding fistula formation in re-do urethroplasty or hypospadias patients with thin urethral plates

Testicular prostheses in children: Is earlier better?

The absence of a testis occurs for various reasons in children, but testicular prosthesis implantation in children is uncommon. The optimal time for prosthesis placement is still unclear, and its complication rate has been poorly studied in children. The aim of this study was to determine the risk factors of complications in cases of testicular prosthesis implantation in children. A monocentric, retrospective review was performed of children implanted with a testicular prosthesis between 2008 and 2014. All implantations were performed through an inguinal incision with a standardized procedure. Children were divided into two groups depending on the interval after orchiectomy: (A) early implantation (delay between surgeries <1 year); and (B) delayed surgeries (delay ≥1 year). Statistical analysis was performed with Student and Fisher tests. Twenty-six patients (A, 15; B, 11) had a total of 38 testicular prostheses placements. Mean follow-up was 36.2 months. First surgery was performed at the mean age of 11.8 years (range 0-17.9) (A, 14.1; B, 8.1; P=0.01) and testicular prosthesis implantation at the mean age of 14.7 years (range 9-18) (A, 14.3; B, 14.6) with a mean delay of 36.1 months (A, 1.3; B, 80.3). Indications were mainly spermatic cord torsion (27%), bilateral anorchia (27%), and testicular atrophy after cryptorchidism surgery (19.2%). Complications (10.5%) included two cases of extrusion, one infection and one migration. Patient 1 had a history of acute lymphoblastic leukemia with testicle relapse 2 years after induction therapy. High-dose chemotherapy, total body irradiation and bilateral orchiectomies were performed, and bilateral prostheses were implanted 12 years after the end of chemotherapy. Complications happened 85 days after surgery. Patient 2 was followed-up for a proximal hypospadias. The tunica vaginalis flap, which was used during a redo urethroplasty, lead to testicular atrophy. Thirteen years after the last penile surgery, a testicular prosthesis was placed through an inguinal incision, and extrusion occurred 203 days after surgery. Bacterial cultures of the prostheses were sterile and histological review showed no sign of granuloma or graft rejection. The complication rate was significantly higher if the delay between the two surgeries exceeded 1 year (P=0.01). Indications of orchiectomy, prior scrotal incision, and prosthesis size were not risk factors. Testicular prosthesis implantation was relatively safe in a pediatric cohort. The complication rate was significantly higher if the delay between the orchiectomy and the prosthetic placement exceeded 1 year. These results suggest that reducing the delay between orchiectomy and prosthesis implantation may lead to fewer complications.

Duration of urethral catheterization after urethroplasty: how long is enough?

To report the impact of duration of urethral catheterization (DUC) on the rate of extravasation on voiding cysto-urethrography (VCUG) and the subsequent need of catheter replacement in urethroplasty. Two hundred nineteen consecutive patients undergoing urethroplasty between October 2010 and November 2014 were evaluated for the impact of DUC. Patients were divided into 2 groups, based on the scheduled DUC≤10 days (group 1, N.=86) or >10 days (group 2, N.=133). Fourteen patients (6.4%) had extravasation on VCUG with an additional period of catheter usage. In 10 of the 14 patients (71.4%) clinical signs of impaired wound healing were present. In group 1 (median DUC 8 days) 3 patients (3.5%) needed an additional period of urethral catheterization, compared to 11 patients (8.3%) in group 2 (median DUC 14 days). Strictures in group 2 were longer (4 vs. 2 cm, P<0.001) and more complex. Redo urethroplasty was needed in 9 of the 14 patients with extravasation. In uncomplicated cases of urethroplasty, the urethral catheter can be safely removed after 8 to 10 days postoperatively. Extravasation on VCUG occurs in around 6% of urethroplasties and is a prognostic factor for stricture recurrence and reoperation.

Management of recurrent anterior urethral strictures following buccal mucosal graft-urethroplasty: A single center experience.

Objective:To describe the safety, feasibility and outcome of redo buccal mucosal graft urethroplasty in patients presenting with recurrent anterior urethral stricture following previous failed BMG urethroplasty.Materials and Methods:This was a retrospective chart review of 21 patients with recurrent anterior urethral stricture after buccal mucosal graft urethroplasty, who underwent redo urethroplasty at our institute between January 2008 to January 2014. All patients underwent preoperative evaluation in the form of uroflowmetry, RGU, sonourethrogram and urethroscopy. Among patients with isolated bulbar urethral stricture, who had previously undergone ventral onlay, redo dorsal onlay BMG urethroplasty was done and vice versa (9+8 patients). Three patients, who had previously undergone Kulkarni-Barbagli urethroplasty, underwent dorsal free graft urethroplasty by ventral sagittal urethrotomy approach. One patient who had previously undergone urethroplasty by ASOPA technique underwent 2-stage Bracka repair. Catheter removal was done on 21st postoperative day. Follow-up consisted of uroflow, PVR and AUA-SS. Failure was defined as requirement of any post operative procedure.Results:Idiopathic urethral strictures constituted the predominant etiology. Eleven patients presented with stricture recurrence involving the entire grafted area, while the remaining 10 patients had fibrotic ring like strictures at the proximal/distal graft-urethral anastomotic sites. The success rate of redo surgery was 85.7% at a mean follow-up of 41.8 months (range: 1 yr-6 yrs). Among the 18 patients who required no intervention during the follow-up period, the graft survival was longer compared to their initial time to failure.Conclusion:Redo buccal mucosal graft urethroplasty is safe and feasible with good intermediate term outcomes.

Is combined inner preputial inlay graft with tubularized incised plate in hypospadias repair worth doing?

It has been noted that after tubularized incised plate urethroplasty (TIP) repair, the final meatal position is glanular but not at the optimum position. Inner preputial inlay graft combined with tubularized incised plate (G-TIP) has been proposed for redo urethroplasty. We extended this indication to be the standard technique for primary hypospadias repair. We conduct this prospective study to obtain a wide, slit-like appearance neomeatus at the optimum position in the glans proper and to judge if hypospadias repair complications differ from TIP repair in the published data in the literature. This prospective study included 230 consecutive patients who underwent this technique. The study was conducted from November 2011 to August 2014 for all hypospadias cases to be repaired in a single stage regardless of the width and depth of urethral plate or the glans size and shape. Localization of the meatus was glanular in 13 patients, coronal in 75, distal penile in 112, mid penile in 25 and proximal in five. The urethral plate was incised deeply and extended distally beyond the end of the plate by 3 mm in glans proper. The mucosal graft was harvested from the inner prepuce, inlayed and quilted in the incised urethral plate. The neourethra was created over a urethral catheter in two layers. The vascular dartos flap was mobilized dorsally and moved ventrally to cover the neourethral suture line as a barrier. The follow-up period ranged from 5 to 36 months. Excellent cosmetic and functional results were achieved in 221 of 230 patients (96.09%). Neither meatal stenosis nor urethral diverticulum were encountered. An excellent glanular position of a wide slit-like neomeatus was achieved using this technique. Nine patients (3.91%) developed urethrocutaneous fistula. Excellent urinary stream was reported by parents. Combined inner preputial graft with TIP urethroplasty secures the optimal glanular position of a wide slit-like neomeatus because of extension of the incision beyond the end of the plate, thus optimizing functional and cosmetic outcome with no meatal stenosis.

Direct Visual Internal Urethrotomy after Failed Bulbar Urethroplasty

Introduction: Ideal management of failed bulbar urethroplasty is ill defined. The role of direct visual internal urethrotomy (DVIU) as salvage treatment for failed urethroplasty warrants exploration. Material and methods: Patients who failed urethroplasty (buccal or anastomotic) for bulbar urethral stricture from April 2000-April 2013 were reviewed. Demographics, prior treatments, stricture length, and operative approach were evaluated for risk of salvage DVIU failure. Results: Forty-five patients underwent 11 anastomotic and 34 buccal mucosal urethroplasties. Mean stricture length was 3.9cm (0.5- 9cm), mean follow-up was 40 months (12-160 months) and mean time to failure was 20 months (1-133 months). Upon failure, 4 patients underwent redo urethroplasty, and 41 underwent DVIU. Patients treated with immediate redo urethroplasty had no recurrence. 56% (23/41) treated with initial DVIU had no recurrence. Analysis of age, original and recurrent stricture length, and number of preoperative dilations or DVIUs showed no difference between those with and without recurrent stricture after DVIU. No significant difference in failure of salvage DVIU between anastomotic and buccal mucosal grafting was seen. Cox regression analysis showed no significant difference in time to recurrence after salvage DVIU based on anastomotic versus buccal (p=0.3), initial or recurrent stricture length, total prior dilations or DVIUs, and age. Secondary salvage procedures included 11 urethroplasties (successful in 8/11(72%)), and 5 redo DVIU (successful in 2/5 (40%)). Conclusions: Salvage DVIU is an appropriate initial treatment of recurrent bulbar urethral stricture after urethroplasty. When this fails, redo urethroplasty has a high success rate.

Our experience, technique and long-term outcomes in the management of posterior urethral strictures

PurposeTo share our experience, technique and long-term outcomes in posterior urethral stricture management. Materials and methodsThirty-seven boys with post-traumatic posterior urethral stricture underwent resection and end-to-end anastomosis through pre-anal coronal approach or in combination with trans-pubic approach from January 2000 to December 2011. Follow up included symptomatic evaluation by micturating cystourethrogram and retrograde urethrogram in all patients, and urethroscopy in patients with voiding symptoms. ResultsPre-anal coronal approach was used in 29 (78%) cases and in 8 (21%) cases it was combined with trans-pubic approach. In 33 (89.1%) patients it was first attempt, while in 4 (10.9%) it was redo surgery. Two patients required buccal mucosal graft to bridge the deficient urethra. Patient age was 5–17 years (mean 10.8 years). Mean follow up was 48.5 months (range 6–132 months). Thirty-two (86%) patients were symptom free. Failed repairs were successfully managed by urethral dilation in 3 and by redo urethroplasty in the remaining 2. All patients were continent. There was no chordee, penile shortening or urethral diverticula. ConclusionsResection and end-to-end anastomosis of posterior urethral stricture is possible through pre-anal coronal incision; however, if slightest difficulty is envisaged in creating a satisfactory end-to-end anastomosis, extension to trans-pubic approach should be done.

Modified Snodgrass tubularized incised plate urethroplasty prevents fistula formation in hypospadias

Urethrocutaneous fistula is a common complication after redo urethroplasty for hypospadias, or urethroplasty for patients with thin urethral plate. We modified Snodgrass' tubularized incised plate urethroplasty (STIPU) by stripping the most superficial skin from both sides of the U-shaped incision to expose more subcutaneous tissue along the suture line. Our modified STIPU would appear to be effective in preventing postoperative urethrocutaneous fistula formation in redo urethroplasty for hypospadias, and urethroplasty for patients with thin urethral plate.

Observational retrospective study on acquired megalourethra after primary proximal hypospadias repair and its recurrence after tapering

IntroductionAcquired megalourethra (AMU) after repair of proximal hypospadias can be a serious complication. An observational retrospective study of its incidence among different types of repair was performed. Materials and methodsClinical charts of patients operated on for proximal hypospadias were reviewed. Inclusion criteria: all primary hypospadias operated in 1991–2004, with the meatus positioned in proximal penile, scrotal or perineal position. ResultsOf 770 hypospadias cases treated, 130 (16%) were proximal. Seventy-two patients (55%) were treated using preputial flaps: 36 with a tubularized preputial island flap (TIF) and 36 an onlay island flap (OIF). Fifty-eight patients (45%) underwent staged repairs: Belt-Fuquà (BF) in 18 and Bracka procedure in 40 cases. After a mean follow up of 16 years (range 6–19) the overall incidence of complications for each technique was: TIF 36%; OIF 33%; BF 25%; two-stage Bracka 7.5%. The most common complication encountered was neo-urethral fistula. AMU occurred in only 5 cases, none with associated distal urethral stenosis, all in the TIF and OIF groups, and all successfully treated by reduction re-do urethroplasty. ConclusionA very small number of the patients operated using preputial island flaps techniques developed AMU. None of the staged repairs developed AMU, and this is the preferred choice in proximal hypospadias when the urethral plate requires division and/or substitution. All cases of AMU resolved after urethral tapering.

5 REDO URETHROPLASTY AFTER FAILURE OF END-TO-END ANASTOMOTIC BULBAR URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 20125 REDO URETHROPLASTY AFTER FAILURE OF END-TO-END ANASTOMOTIC BULBAR URETHROPLASTY Andre Cavalcanti and Mauricio Rubinstein Andre CavalcantiAndre Cavalcanti Rio de Janeiro, Brazil More articles by this author and Mauricio RubinsteinMauricio Rubinstein Rio de Janeiro, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.047AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES End-to-end anastomotic urethroplasty (EEA) for bulbar urethral stricture is associated with excellent long-term success rate: superior to 90% in the majority series. The management of the failures after this type of surgery is an uncommon subject on the literature . The aim of this study is to describe our experience with the surgical management of failures after EEA for bulbar urethral strictures. METHODS The charts of 33 patients submitted to a redo urethroplasty after failure of EEA for bulbar strictures were analysed. All surgeries were performed by the same surgeon between january 2006 and march 2011. The mean follow-up was 30.8 months (range from 6 to 63 months). The mean age was 45.9 years (range from 21 to 83 years). Successful urethral reconstruction was defined as normal voiding (max. flow rate > 15 ml/s) without the need for any postoperative procedure. All patients with max. flow rate < 15 ml/s were submitted to a urethrogram or cystoscopy to evaluate the urethral caliber. The stricture length range from 1 cm to 4 cm (mean of 2,8 cm). RESULTS 29 (87.9%) patients were treated with a single stage procedure and 4 (12.1%) with a staged procedure with buccal mucosa graft (BMG). In 6 (18.2%) patients a new EEA was performed and 23 (69,7%) were treated with a single staged substitution urethroplasty witha a BMG in diferent techniques: ventral onlay (4), dorsal onlay (9), dorsal augmented urethroplasty (7) and double graft (3). The success rate was 81,8% (27 pts) , with 6 failures. Permanent erectile dysfunction were observed in 5 patients (15.2%) and ejaculatory symptoms in 7 patients (21.2%). CONCLUSIONS Good success rate can be expected after a redo urethroplasty on bulbar urethra. The use of a diversity of techniques is necessary to find the best procedure for each patient, regarding the stricture characteristics: lenght, position and spongiosum quality. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e2 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Cavalcanti Rio de Janeiro, Brazil More articles by this author Mauricio Rubinstein Rio de Janeiro, Brazil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Current concepts in the management of pelvic fracture urethral distraction defects

Objectives:Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty.Materials and Methods:A PubMed™ search was performed using the keywords “pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty.” The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty.Results:Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day.Conclusions:Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition.