Straddle Injury Research Articles

Straddle Injuries

Straddle Injuries

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities

ObjectivesTo retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities.MethodsThe study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery.ResultsThe clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18–59) and 26.8 ± 4.4 (riding group, aged 19–35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05.ConclusionsMale bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.

Incidence of urethral stricture in patients with urethral trauma: a 10-year experience in an Indonesian tertiary hospital

BACKGROUND Urethral injuries are rarely life-threatening but can cause significant morbidity if left untreated. Until now, data on urethral trauma incidence are still limited in Indonesia. This study aimed to report the incidence of traumatic urethral stricture within 10 years of experience in treating urethral trauma. METHODS This retrospective study used a total sampling method for all patients with urethral trauma who came to the emergency department and agreed to undergo radiological evaluation. Patient data were collected from January 2012 to December 2021. All patients were followed up for 3 months after trauma, and the incidence of urethral stricture was analyzed using the chi-square or Fisher's exact tests as an alternative. RESULTS The overall incidence of urethral stricture was 48.4%. Of 122 patients, 82.0% had anterior urethral trauma. Grade III American Association for the Surgery of Trauma (43.4%) was the most common urethral trauma. The cause of urethral trauma was iatrogenic, pelvic fracture urethral injury (PFUI), straddle injury, and penile fracture, contributing in 64.8%, 18.0%, 16.4%, and 0.8% of the cases, respectively. Most patients (70.5%) underwent a cystostomy catheterization procedure as initial treatment. Straddle injury, PFUI, and a higher degree of urethral trauma were significantly associated with urethral stricture formation (p&lt;0.05). CONCLUSIONS Straddle injury, PFUI, and a higher degree of urethral trauma were significantly related to a higher incidence of urethral stricture. Most low-grade and anterior urethral traumas can resolve spontaneously.

A survey of emergency blunt urethral injury management in China: Reality versus guidelines

AbstractBackgroundAlthough urethral trauma may lead to serious consequences if mismanaged, treatment concepts are inconsistent. We designed a survey to investigate the current diagnosis and management of emergency blunt urethral trauma to aid future dissemination of relevant concepts.MethodsA 15‐item anonymous questionnaire was distributed via an online platform. It addressed items such as the cognition of how to diagnose of urethral trauma, optimal emergency management of a urethral trauma patient, and attitude towards early realignment for pelvic fracture urethral injuries.ResultsOf 538 respondents, 94.2% and 84.9% had received patients with straddle trauma urethral injuries or pelvic fracture urethral injuries, respectively, within the past year. In the emergency room, attempted urethral catheterization was the most selected examination method by respondents for diagnosis of both straddle injury (500/538) and pelvic fracture urethral injury (469/538). For patients with straddle injury, 41.3% of respondents performed endoscopic realignment and 31.6% preferred suprapubic cystostomy. For hemodynamically stable patients with PFUI, 42.2% of respondents preferred suprapubic cystostomy and 34.9% preferred endoscopic realignment. Most respondents felt favorably toward early realignment for pelvic fracture urethral injuries. After realignment, 61.3%, 24.5%, and 13.8% of respondents performed catheterization for 4, 8, and 12 weeks, respectively. Further, 54.6% of respondents believed catheter traction should be applied after realignment.ConclusionAlthough the number of yearly emergency urethral trauma cases was small, the opinions and practices of most urologists were consistent with guidelines. However, the significance of retrograde urethrography was not fully understood, and some respondents had incorrect views on catheter traction after realignment.

(417) Erectile Function after Treatment for Non-ischemic Priapism

Abstract Introduction Non-ischemic priapism (NIP) is a rare subtype of priapism that typically arises from a straddle injury leading to the formation of an arterial-sinusoidal fistula, which results in partial penile tumescence. NIP can be managed conservatively, with selective arterial embolization, or, rarely, with surgical arterial ligation. These treatments have varying rates of success and post-treatment erectile dysfunction (ED), but there is a paucity of studies that include long-term outcomes. We present long term follow up of 23 three patients in a large centre offering all interventions. Objective Follow up 23-patients presenting with non-ischemic priapism, evaluating long term erectile function in both those who did and didn’t require intervention in the form of embolization. Methods We conducted a single-centre retrospective cross-sectional study looking at erectile function (EF) in a cohort of 23 patients over a median follow-up of 61 months. Patients’ EF was assessed using the erectile function domain (IIEF-EF) of the British Association of Urological Surgeons (BAUS) International Index of Erectile Function (IIEF) questionnaire, and ED was defined as a score ≤ 25 and/or the use of pharmacological adjuncts to assist EF. This is the largest and longest study in this field of its type. Results o Our cohort had a median IIEF-EF score of 28, and 4 patients (17.4%) reported using adjuncts. 21 patients were treated with embolization, and 2 were managed conservatively. o 91.3% required treatment with embolization, 17.4% needed adjunctive agents o 4.3% reported suffering a further episode of priapism (single iatrogenic episode) o 0% ED in conservative management group, 47.6% ED in embolization group. Conclusions We had a higher ED rate with embolization compared to the literature (47.6% vs 15-22%). Although no patients treated conservatively had ED at follow-up, there were only 2 patients in this group. Our study’s validity is negatively affected by many factors: its retrospective nature, a small sample size, and confounding from a heterogeneous group of patients. Ultimately, NIP is a rare condition with good treatment outcomes which are constantly improving and evolving. Disclosure No

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury. Iatrogenic urethral injury is often caused by traumatic catheterization and is best managed by an attempted catheterization performed by an experienced clinician or suprapubic catheter to maximize urinary drainage. Penetrating trauma, most commonly associated with gunshot wounds, can cause either an anterior and/or posterior urethral injury and is best treated with early operative repair. Blunt trauma, most commonly associated with straddle injuries and pelvic fractures, can be treated with either early primary endoscopic realignment or delayed urethroplasty after suprapubic cystostomy. With any of the above injury patterns and treatment options, a well thought out and regimented follow-up with a urologist is of utmost importance for accurate assessment of outcomes and appropriate management of complications.

Complex penile fracture after straddle injury: A case report

Introduction: Penile fracture due to staddle injury is an underreported surgical emergency. Fall down in perinium can present with not only scrotum/perinium hematoma but can associated with more complicated injuries such as pelvis fracture, complex penile fracture with urethral injury, corpus cavernosal and spogiosium raptures. These findings lead to worse morbidity in the patient, especially in terms of sexual life and urinary symptoms. If such severe injuries are not properly managed, erectile dysfunction and urethral stricture can happen, leading to more complicated problems. Case Report: A 23-year-old male presented to the emergency department with complaints of scrotal swelling and pain for three hours due to fall from height on perinium. He had classic signs of a urethral injury and penile fracture. Conclusion: Penile fracture is not always spared injury and does not always occur during erection, but is sometimes associated with other injuries and in flaccid phase.

The treatment practices for anterior urethral strictures in China: A case-based survey.

ObjectiveTo investigate the treatment concept of Chinese urologists for anterior urethral strictures based on actual cases.MethodsA self-designed case-based questionnaire was distributed to the members of Official WeChat account of Learning Union from March 19, 2020, to April 10, 2020. Questionnaires requested respondents' demographic information and responses to five cases of anterior urethral stricture: short obliterative bulbar urethral stricture caused by straddle injury (Case 1), idiopathic bulbar urethral stricture after failure of multiple endoscopic therapy (Case 2), iatrogenic long penile urethral stricture (Case 3), lichen sclerosis-related urethral stricture (Case 4), and anterior urethral stricture in indwelling catheter after multiple failure of endoscopic surgery (Case 5). Data was described by frequency and percentage.ResultsA total of 1,267 valid anonymous questionnaires were received. Urethroplasty was recommended more frequently than endoscopic surgery (Case 1: 47.8% vs. 32.8%,Case 2: 42.5% vs. 33.8%, Case 3: 36.1% vs. 26.7%). Referrals patients to other urologists engaged in urethral repair and reconstruction account for a high portion of the treatment (Case 1:18.4%, Case 2:23.1%, Case 3:36.5%, Case 4:27.7%,Case 5:9.3%). Excision and primary anastomosis urethroplasty (EPA) was preferred for treatment of Case 1 (42.5%). For Case 2, the most popular choice was EPA (30.6%). Although the patient has a history of failure in endoscopic surgery, 33.8% of urologists continue to choose endoscopic surgery. For Case 3, 20.0% of urologists would perform oral mucosal urethroplasty. Surprisingly, 5.9% chose EPA. For Case 4, 37.3% of urologists selected meatotomy, 30.4% suggested that glans and urethral biopsies should be performed. 21.0% chose to use steroid ointment after surgery. For Case 5, 26.3% of the respondents believed that urethrography should be performed after removing catheter more than one week, if the urine is obstructed during the period, performing cystostomy firstly.ConclusionsIn China, the concept of urethroplasty is more widely accepted than endoscopic surgery for the treatment of anterior urethral strictures. The concept of referral has been widely formed among Chinese urologists. Better understanding of the comprehensive treatment of lichen sclerosis related anterior urethral stricture and the principle of urethral rest should be strengthened.

Severe Allergic, Inflammatory and Traumatic Reactions of the Vestibule Associated with Acquired Neuroproliferative Vestibulodynia

ABSTRACT Introduction The endodermal vestibule epithelial surface is very thin (∼ 50 um) and unlike the ectodermal vulva has no protective keratinized stratified squamous epithelium, therefore the vestibule is particularly susceptible to injury as a reaction to allergy, inflammation, or trauma. In some women these injuries result in excess mast cell and nerve accumulation in the vestibular epithelium and stroma, leading to neuroproliferative vestibulodynia (NPV). Acquired NPV is diagnosed by first obtaining a detailed history. Penetration must have initially been pain-free, followed by persistent entrance dyspareunia after exposure of the endodermal vestibule to: a topical agent causing a severe allergic reaction such as an antifungal vaginal cream; recurrent inflammatory conditions including vaginal candidiasis; or repeated blunt trauma, as with horseback riding. Acquired NPV is often observed in women with very sensitive genital skin. There are limited data regarding the various agents and conditions associated with acquired NPV. Objective The objective of this study was to examine the various agents and conditions that potentially caused NPV among our patients. Identification of iatrogenic or other topical triggers of NPV could inform both providers and the public of agents to potentially avoid applying these to the vestibule. Methods A retrospective chart review of women who underwent complete vestibulectomy for suspected NPV between June 2019 – November 2021 was performed. Inclusion criteria for this study: i) a history consistent with acquired NPV, ii) undergone vulvoscopy to rule out other forms of vestibulodynia, iii) a positive vestibular anesthesia test, iv) treatment by complete vestibulectomy with vaginal advancement flap, and v) a diagnosis of neuroproliferative vestibulodynia confirmed by immunohistochemical staining of excised vestibular tissue by CD117 and PGP9.5. Results A total of 47 charts were reviewed: 43% (n = 20, mean age 34 ± 15 years) had acquired NPV and met inclusion criteria; 57% (n = 27, mean age 28 ± 10 years) had congenital NPV. A history of entrance dyspareunia following a severe allergic reaction to a topical agent occurred in 12 women, the most common substance being topical miconazole (n=7, 58%). Other topical agents included a hotel shampoo (n=1), hair dye (n=1), lubricant (n=1), scented soap (n=1), and spermicide (n=1). Four (20%) reported recurrent inflammatory conditions including vaginal candidiasis treated with oral medication; four (20%) reported symptoms after blunt perineal trauma including a 30 fall from a waterfall (n=1), horseback riding (n=1), bicycle riding (n=1), and straddle injury (n=1). Eight patients (40%) reported having sensitive genital skin. Conclusions In our patient population, the most common agent triggering NPV was topical miconazole which contains inactive ingredients that may be associated with allergic reactions including: benzoic acid, beta hydroxy acid, peglicol 5 oleate, and pegoxol 7 stearate. Since the endodermal vestibule epithelium is thin without keratin, making it vulnerable to injury, topical agents to the vestibule, especially when it is inflamed, should be avoided and oral agents for inflammatory conditions be considered when appropriate. Women often purchase over the counter topical miconazole without knowledge of the potential side effects. Disclosure No

Man With Groin Pain

A 19-year-old male patient was transferred to the emergency department after a motorcycle accident. His main complaint was pain in the left groin and scrotum. He was hemodynamically stable and had a firm, movable, and tender mass over the left groin (Video E1 [available at http://www.annemergmed.com]). The testis in the left scrotum could not be palpated (Figure 1). The emergency physician performed ultrasonography that revealed normal echotexture of testis without hematoma or focal lesions (Figure 2) and confirmed the diagnosis by computed tomography (Figure 3).Figure 2Sonography of the left groin mass in the sagittal plane showed ovoid and homogeneous echogenicity, which favor a normal testis image.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Computed tomography image of the abdomen and pelvis in the axial view with intravenous contrast demonstrating dislocation of the testis over the left inguinal region.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Traumatic testicular dislocation. The patient underwent a successful manual testicular reduction in the emergency department. Unfortunately, the testicle redislocated easily, and a urologist performed successful surgical exploration and orchiopexy. Traumatic testicular dislocation is a rare complication of scrotal trauma, typically resulting from straddle injury sustained in a motorcycle collision. The most common dislocation site is the superficial inguinal region, accounting for >50% of cases. Successful manual reduction includes normal scrotal anatomic positioning and immediate pain relief. However, this may only be possible in 15% of cases given the small size of the defect in spermatic cord layers, edema of the scrotal wall, and the possibility of further testicular damage.1Tai Y.S. Chen Y. Tsai P. et al.Traumatic testicular dislocation: a rare occurrence of blunt scrotal injury.Urol Sci. 2014; 25: 158-160Abstract Full Text Full Text PDF Scopus (4) Google Scholar Surgical repair is required if manual reduction fails or there are coexisting injuries.2Subramaniam S. Ab Khalil M.K. Zakaria J. et al.Managing traumatic testicular dislocations: what we know after two centuries.BMJ Case Rep. 2020; 13e236801Crossref Scopus (3) Google Scholar,3Riaza Montes M. Palacios Ramos J. Gallego Sánchez J.A. Testicular dislocation: an atypical case and review of the literature.Urol Case Rep. 2020; 33: 101405Crossref PubMed Scopus (2) Google Scholar https://www.annemergmed.com/cms/asset/bd128463-f101-4c82-8a09-caa0deea2109/mmc1.mp4Loading ... Download .mp4 (2.74 MB) Help with .mp4 files Video E1

Radiologic Imaging Does Not Add Value for Female Pediatric Patients with Isolated Blunt Straddle Mechanisms

Study ObjectivesThe purpose of this study was to characterize the utility of radiologic imaging and examination under anesthesia in female pediatric patients with isolated blunt straddle injuries. DesignRetrospective review. SettingSingle health care system with a children's hospital and level 1 pediatric trauma center. ParticipantsFemale patients aged 1-17 years with blunt straddle injuries from 2006 to 2018. InterventionsNone. Main Outcome MeasuresRadiologic imaging performed, number of patients requiring exam under anesthesia (EUA), number of injuries not identified in patients who did not undergo EUA. ResultsThe study cohort included 83 patients. Of these, 11 (13%) had imaging performed. Thirty-four patients were managed as outpatients, 28 were discharged from the emergency department without need for intervention, and 49 patients were admitted. Of these, 48 (98%) went to the operating room for exam EUA. No occult injuries were identified on radiologic studies. Imaging was not associated with need for EUA. No missed injuries occurred in children who were not imaged. Two patients who were imaged returned for EUA following evolution of symptoms. ConclusionRadiologic imaging did not add diagnostic value for female pediatric patients with blunt straddle injuries. These data emphasize the importance of EUA with repair and advocates for minimization of radiologic imaging in this patient group.

Blunt Injury Abdomen with Complete Vesico-Urethral Transection in a Female Child

Traumatic bladder neck distraction injury in children is an uncommon but potentially dangerous occurrence. Straddle injuries produced by a hit to the perineum as a result of striking an outside object with the power of one’s body weight, as well as significant urethral trauma caused by a pelvic fracture, occur in both sexes. Urethral injuries in females are infrequent and are typically associated with pelvic fractures and anterior vaginal wall laceration. We offer a case report of a girl who had a full vesicourethral transection following a traumatic injury to the abdomen, as well as a rupture of the dome of the urinary bladder, and was treated with early urethro-vesical anastomosis and bladder closure. Patient recovered well after surgery, was continent, and had excellent urine flow rates.

Non-Obstetric Traumatic Vulvar Hematomas in Premenarchal and Postmenarchal Girls

Traumatic non-obstetrical hematomas of the vulva are rare, and most reports only involve adult patients. There are no data on presentation, management, and outcomes from either conservative or surgical management in pediatric and adolescent patients. The objective of this project was to compare the etiology, treatment, and outcomes of traumatic vulvar hematomas occurring in premenarchal and postmenarchal young women. A retrospective chart review was performed on females aged 0-24 years seen at a tertiary care academic center using ICD 9 and 10 codes for traumatic vulvar hematoma from 2006-2019. Data describing their clinical presentation and course were collected. IRB approval was obtained. Twenty patients, aged 3-23 years (median age of 13.5 years) were identified. All 8 premenarchal patients presented with a straddle injury, whereas only 50% of postmenarchal patients were found to have a straddle injury. Other etiologies among postmenarchal patients included consensual sexual intercourse and recent vulvar surgery. Hematoma diameter ranged from 1-3 cm in premenarchal patients and 0.4-7 cm in postmenarchal patients. Associated perineal lacerations were reported in 50% of the premenarchal girls and 8% of postmenarchal young women. Of the 8 premenarchal patients, 5 were managed conservatively, and 3 were taken to the operating room for repair of perineal lacerations; 1 patient also underwent evacuation of a 3-cm hematoma. Of the 12 postmenarchal patients, 5 had surgical intervention, 2 for pain secondary to large 7-cm hematomas and 3 for suspected vulvar abscesses, which were identified as hematomas after drainage. One patient in each group required a Foley catheter for comfort. Two postmenarchal patients required a second surgery for further wound management. One premenarchal patient with surgical treatment required a follow-up exam under anesthesia. Four patients were admitted for pain and postoperative observation, 1 of whom was premenarchal. Eleven patients were seen for follow-up, and 10 were doing well. One postmenarchal patient in the conservative management group returned to the Emergency Department with continued pain 10 days later. In this study that examined traumatic vulvar hematomas in premenarchal and postmenarchal young women, the only mechanism of injury in premenarchal girls was straddle injury, and surgical intervention was usually needed only for repair of perineal lacerations, not a primary hematoma. In the postmenarchal patients, surgical intervention was undertaken for larger hematomas and suspected vulvar abscesses. Our study suggests that most hematomas up to 3 cm in premenarchal patients and up to 6 cm in postmenarchal patients can be managed conservatively.

Persistent Unilateral Labial Swelling After Straddle Injury and Contralateral Hematoma Evacuation

Background: Blunt trauma to the external female pelvis or “straddle injury” can usually be managed conservatively. Emergent surgery is indicated for unstable bleeding, need for thorough exam with penetrative trauma or expanding hematoma. Long-term complications after a straddle injury may include pain, scarring, recurrent hematoma or persistent edema.

Outcomes of early endoscopic realignment for blunt straddle injuries to the bulbar urethra: a single-center retrospective study

BackgroundThe optimal acute management of patients with blunt straddle injury to the bulbar urethra remains in question. Conventionally, suprapubic diversion with delayed urethroplasty can always be considered, if necessary, but the role of early endoscopic realignment (EER) in the acute management of blunt straddle injuries to bulbar urethra is controversial. We report our clinical experience and outcomes with EER for patients with straddle injury to the bulbar urethra in a level one trauma center.MethodsWe retrospectively reviewed 44 male patients who were transferred to our trauma center between January 2013 and January 2019 for acute management of blunt straddle injury to the perineum leading to bulbar urethra injuries. We reviewed the medical records of those patients to identify demographics, emergency management and clinical outcomes.ResultsThe most common injury mechanism was falling onto the perineum (n = 27, 61.4%), followed by motorcycle accident (n = 11, 25.0%) and bicycle accident (n = 6, 13.6%). Of the 44 patients, 14 (31.8%) were partial bulbar urethral ruptures and 30 (68.2%) were complete bulbar urethral ruptures. 31 (70.5%) patients successfully underwent EER and 13 (29.5%) patients failed attempted EER. the difference between successful EER attempts and failed ones in term of injured urethral mucosa integrity was statistically significant (P = 0.035, OR 8.667,95% CI: 0.998–75.235). In patients who underwent successful EER, urethral stricture occurred after catheter removal at a median of 8 (1–28) months in 24 (77.4%) patients and the mean stricture length was 1.8 ± 0.8 (0.5–3.0), which was not statistically significant when compared with those who failed EER (P = 0.103). Overall, 21 out of 24 (87.5%) patients with strictures after EER were successfully managed by urethroplasty.ConclusionsAlthough achieving a successful EER attempt is relatively easy for most patients with straddle injury to the bulbar urethra, it does not improve urethral healing significantly. Most patients with stricture formation after EER have to be cured with urethroplasty.

EFFECT OF MURCHHIT TILA TAILA UTTARBASTI IN MANAGEMENT OF URETHRAL STRICTURE - A CASE STUDY

In Geriatric patients, urological problems like dribbling micturition, burning micturition, dysuria etc. are commonly seen due to Urethral Stricture, BPH, Chronic urinary tract infection, Urinary Incontinence, Over-active bladder etc. In this study, we will discuss the effect of the Ayurvedic Panchkarma Procedure i.e., Uttarbasti in Urethral Stricture. Urethral Stricture involves scarring that narrows the tube that carries urine out of the body mostly due to STD’s, Catheterisation, straddle injury to the perineum. Newer Surgical Techniques like Urethral Dilatation, DVIU, Ure- throplasty etc are used but they are painful, expensive &amp; has recurrences. In Ayurvedic literature, Mutra mar- gasankoch and Mutrotsanga are an entity that can be closely related to urethral stricture which is described by Acharya Sushruta in Uttartantra. In this case study, a 45-year-old male patient suffering from LUTS Came to Shalya OPD undergone repeated urethral dilatations but was unrelieved. So, after clinical evaluation &amp; Investiga- tions, the case was diagnosed as Urethral Stricture &amp; treated with Uttarbasti. In this case study, Murchhit Tila Taila for the Uttarbasti procedure was used. After the Procedure results were evaluated &amp; the results are satisfying. Keywords: Uttarbasti, Murchhit Tila Taila, Urethral Stricture

Teaching Pediatric Straddle Injury Repair with Use of a 3D Printed Model.

To determine the utility of a 3D vulvar model for teaching pediatric straddle injury repair. Prospective study. Two academic hospitals. Twenty obstetrics and gynecology residents INTERVENTIONS AND MAIN OUTCOME MEASURES: Knowledge score on the basis of a 7-question pre/post test. Likert scale questions evaluated the 3D model as a teaching tool. Twenty residents participated; 2 (10%) had ever repaired a straddle injury. Knowledge scores increased after model use and didactic session from 3.05 of possible 7 to 6.35; P=.001. Only 2/20 (10%) residents "agreed" or "strongly agreed" with the statement, "I am comfortable repairing a straddle injury" before the intervention, compared with 19/20 (95%) afterward (P < .001). Of 20 residents, 19 (95%) believed that it simulated surgical experience "very well" or "well." The use of a 3D pediatric vulvar model can simulate surgical experience and can be an effective teaching tool when combined with a didactic session on pediatric straddle injury.

Acute Ischemic Priapism: An AUA/SMSNA Guideline.

Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.