Traumatic Urethral Disruption Research Articles

Traumatic Posterior Urethral Strictures in Children and Adolescents.

Background: Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. We reviewed the urological literature related to the treatment of traumatic posterior urethral injuries and delayed repair of these distraction defects in children and adolescents.Material and Methods: There are few long-term outcomes studies of patients who underwent PFPUDDs repairs in childhood; most reports included few cases with short follow up. We excluded studies in which the cohort of patients was heterogeneous in terms of stricture disease, etiology and location.Results: Primary cystostomy and delayed urethroplasty is the traditional management for PFPUIs. Immediate repair is rarely possible to perform. Realignment of posterior urethral rupture in children is indicated in special situations: (a) concomitant bladder neck tears, (b) associated rectal lacerations, (c) long disruptions of the urethral ends. Before delayed reconstruction ascending urethrography and micturating cystourethrogram along with retrograde and antegrade urethroscopy define site and length of the urethral gap. However, the most accurate evaluation of the characteristics of the distraction defect is made when surgical exposure reveals the complexity of the ruptured urethra. Partial ruptures may be managed with urethral stenting or suprapubic cystostomy, which may result in a patent urethra or a short stricture treated by optical urethrotomy. The gold standard treatment for PFPUDDs in children is deferred excision of pelvic fibrosis and bulbo-prostatic tension-free anastomosis, provided a healthy anterior urethra is present. Timing of delayed repair is at 3 to 4 months after trauma. Some urologists prefer either the perineal access or the transpubic approach to restore urethral continuity in children with PFPUDDs. Substitution urethroplasties are used in children with PFPUDDs, when anastomotic repair can't be achieved due to severe damage of the bulbar urethra.Conclusion: As evidenced in this review the progressive perineo-abdominal partial transpubic anastomotic repair has advantages over the isolated perineal anastomotic approach in patients with “complex” PFPUDD. This approach provides wider exposure and facilitates reconstruction of long or complicated posterior urethral distraction defects

Should primary realignment become the standard line of treatment for traumatic posterior and bulbar urethral disruption?

ObjectivesTo assess early urethral realignment and the correlation of severity of pelvic fracture, with impact of technique on continence and potency. MethodsProspective analysis on patients of post traumatic urethral disruption from 7/2013–5/2015 at Cairo University hospitals. Initial management entailed suprapubic tube insertion. Antegrade flexible cystoscopy or rigid ureteroscopy via the suprapubic access, together with retrograde rigid cystoscopy and real-time fluoroscopy. Follow up entailed history taking, uroflowmetry, urethrograms, cystoscopy, success rate, continence, erectile status after trauma and need for auxiliary procedures after catheter removal. ResultsA total of 18 men with a mean age of 27 ± 15 years. Endoscopic realignment (ER) was performed in 15 out of 18 patients. Open realignment was done in 3 cases. Mean OR time for ER was 30 ± 22 min. Estimated blood loss was minimal. Mean time from injury to primary realignment was 6.0 ± 3.8 days. We found a good correlation between presence of pelvic fracture and grade of urethral injury, but no correlation was found between Tile class and grade of urethral injury. A total of 9 (56.3%) out of 16 patients, who completed follow-up developed 2ry strictures. 6 had narrowing of the urethra and underwent DVIU; 2 of whom had recurrent stricture and needed urethroplasty. 3 had complete obliteration of the urethral lumen and definitive urethroplasty was done. Mean follow up duration 20.6 ± 5.3 months. No patient suffered from UI and only 1 out of 13 adult patients who completed follow up (7.7%) suffered ED. ConclusionsEarly urethral realignment is successful due to advances in endoscopic techniques.

Endoscopic urethral realignment of traumatic urethral disruption: A monocentric experience.

Introduction:The optimal management strategy for urethral injuries remains controversial. Suprapubic cystostomy followed by delayed urethral reconstruction or immediate primary urethral injury repair is associated with high complication rate. Early endoscopic realignment for urethral injuries provides early definitive procedure with low complications and avoids the need for further urethral reconstruction.Materials and Methods:Between April 2007 and March 2016, 27 patients with traumatic posterior urethral disruptions were reviewed. All patients were managed by endoscopic urethral realignment. Patients were followed up every 3 months for 18–36 months regarding incontinence, potency, and urine flow.Results:Endoscopic urethral realignment was performed immediately in 21 patients and was delayed in 6 patients. It was successful in 24/27 (88.8%) patients. During the procedure, the proximal urethral end was identified directly in four patients, and by the guidance of methylene blue injection, guidewire or endoscopic light in three, nine, and eight patients, respectively. The Foley catheter was removed after 9 weeks in 17/24 (70.8%) patients and after 12 weeks in 7/24 (29.2%) patients. Six months after realignment, minimal urethral stricture was developed in 4/24 (16.7%) patients. All of them were treated successfully with single session of internal urethrotomy without recurrence after 1-year follow-up. After 18–36-month follow-up period, all patients were potent, continent, and with satisfactory voiding pattern.Conclusions:Endoscopic primary realignment of posterior urethral rupture is less invasive and a safer procedure, without pelvic hemorrhage or additional injuries. It has low incidence of severe urethral stricture and avoids the need for delayed open urethral reconstruction.

Primary Endoscopic Realignment of Urethral Disruption Injuries—A Double-Edged Sword?

Controversy remains regarding initial management of traumatic urethral disruption injuries. We evaluated the outcomes of primary endoscopic realignment vs suprapubic tube placement in this patient population. We reviewed our urological trauma database for patients with blunt trauma related posterior urethral injuries from 2000 to 2014. Patients underwent primary endoscopic realignment or suprapubic tube placement alone. The primary outcome was the success of primary realignment, defined as no further need for urological intervention. Secondary outcomes were the need for endoscopic interventions and/or urethroplasty, time to urethroplasty, urethroplasty success and long-term functional outcomes. A total of 27 patients underwent primary realignment and 14 underwent suprapubic tube placement. Mean followup was 40 months (median 24, range 1 to 152). Realignment was successful in 10 patients (37%) at a mean followup of 67.3 weeks (median 27.3, range 4 to 284). In the 17 cases (63%) that failed mean time to failure was 9.7 weeks (median 8.5, range 1 to 26). Seven patients (26%) treated with realignment and 11 (79%) with a suprapubic tube proceeded to urethroplasty. Mean ± SD time to urethroplasty was significantly shorter in the suprapubic tube group (14.6 ± 7.6 vs 5.8 ± 1.6 months, p = 0.003). There was no difference in operative time, complications, success or functional outcomes. Management of traumatic urethral disruption injuries by primary endoscopic realignment serves as definitive therapy in more than a third of treated patients. It prevents the need for formal urethroplasty in more than half of failed cases.

Early endoscopic realignment of traumatic anterior and posterior urethral disruptions under caudal anaesthesia – a 5-year review

We recently described early rigid retrograde endoscopic realignment of the disrupted urethra under caudal anaesthesia in the outpatient setting. This retrospective study was performed to evaluate our medium-term results. A retrospective review of patients who had early rigid retrograde endoscopic realignment of traumatic urethral disruptions in our institution over a 5-year period was done and the relevant data extracted and analyzed. Fourteen acutely ruptured urethras (10 posterior and four anterior) were endoscopically realigned early in the study period. Nine (90%) of the posterior disruptions occurred at bulbo-membranous urethra (distal to the external sphincter mechanism). Thirteen of the ruptured urethras (93%) were successfully realigned (nine posterior and four anterior) and postoperative clean intermittent self-calibration (CIC) was instituted in 10 patients. The mean follow-up period was 36.6 months (range 18-54 months). The mean operating time and the median hospital stay were 22 min (range 8-68 min) and 3 days (range 1-10 days), respectively, and were shorter in patients with injuries of the anterior urethra than those with posterior urethral tears (p < or = 0.0001). Post-realignment, all 13 patients were potent and continent. Two patients required additional procedures (direct vision internal urethrotomy or urethral dilation) and one patient has remained on CIC i.e. a stricture rate of 21%. Early retrograde endoscopic realignment under caudal analgesia is suitable and cost-effective for patients with acute traumatic urethral disruptions and has good medium-term results. In addition, an early postoperative regimen of CIC significantly reduced stricture-formation in our series.

Immediate endoscopic management of complete iatrogenic anterior urethral injuries: A case series with long-term results

BackgroundUrethral injury produces partial or complete disruption of the urethral integrity. Advances in endourology have made endoscopic management of most of these injuries feasible without greatly compromising the final result. We report our institutional experience of immediate endoscopic realignment of complete iatrogenic anterior urethral injury.MethodsFrom May 1997 to May 2003, seven patients with complete anterior urethral disruption were managed by immediate endoscopy guided splinting of urethra. Retrograde urethroscopy, combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed. A guide wire was negotiated across the disruption. Later, a 16 F Foley catheter was placed for 1–3 weeks. Patients were followed up at 1, 3, 6 and 12 months and then yearly to assess the long-term outcome of endoscopic management.ResultsImmediate endoscopic realignment was achieved in all patients. Three patients developed recurrence at six months; that was treated by optical urethrotomy. Only one patient developed multiple recurrences over an average follow-up of 49.2 months (range 7 to 74 months). He was offered open end-to-end urethroplasty at twenty months after third recurrence. Thus immediate endoscopic realignment avoided any further intervention in four patients (57.14%); while after an additional optical urethrotomy, urethroplasty could be avoided in six patients (87.2%).ConclusionImmediate endoscopic realignment of traumatic urethral disruption is a feasible, safe and effective treatment modality for management of patients with iatrogenic complete anterior urethral injuries.

Rotura traumática de uretra femenina: una rara entidad. aportación de dos casos

Traumatic Urethral Disruption In Women. A Rare Entity. Aportation Of Two CasesWe present two cases of urethral disruption in women, a very uncommon situation because of the anatomical features. Yet it must be always suspected in all women under a pelvic politraumatism, for eviting important problems.Both cases are traffic politraumatized young girls presenting with pelvic fracture, among others.The surgery performed was combined suprapubic-transvaginal approach, even in one a previous endoscopic realinement was done, who also needed endoscopic complementary treatment: electrofulguration of a fistulous bridge.Outcome of both is fine, achieving good continence.We also make a literature review.

Re: Core-Through Urethrotomy Using The Neodymium:Yag Laser for Obliterative Urethral Strictures After Traumatic Urethral Disruption and/or Distraction Defects: Long-Term Outcome

Re: Core-Through Urethrotomy Using The Neodymium:Yag Laser for Obliterative Urethral Strictures After Traumatic Urethral Disruption and/or Distraction Defects: Long-Term Outcome

Management of traumatic urethral disruption in children: Oman experience, 1988-2000

Background: Traumatic urethral disruptions in children differ anatomically from those of adults. In children, the posterior urethra is not protected by the prostate and may be injured at any level. The management of traumatic rupture of the urethra still a matter of debate, and there is no agreement as to which is the best of 3 options. Methods: This was a retrospective analysis. Over a 12-year period the authors dealt with 21 urethral disruptions. The authors had detailed follow-up of 20 patients (14 posterior and 6 anterior). Trans-symphyseal urethroplasty (6 early primary repairs and 3 delayed repairs) for complete posterior urethral disruptions was performed. The early repairs were carried out within 7 days of the injury. Primary alignment was performed for 3 of the 4 partial ruptures of the posterior urethra and for all 6 anterior urethral disruptions. Postoperatively, the patients were evaluated for incontinence, penile erectile dysfunction, and stricture formation. Results: In one of the early repairs a stricture developed that responded to dilatations. A second patient with bladder neck injury had incontinence after the repair. She underwent a urethral lengthening procedure and still has stress incontinence. Erections were observed in all 4 boys. One of the delayed repairs developed a stricture postoperatively. Of the 9 partial ruptures (6 anterior and 3 posterior) that underwent primary alignment, 4 had strictures. Some of these strictures required up to 5 dilatations or internal urethrotomy for cure. One patient with complete rupture underwent primary alignment, which broke down, and a long stricture developed. This patient is still awaiting a delayed repair. One posterior partial rupture, repaired primarily at another hospital, had a stricture and an urethrocutaneous fistula that responded to curettage and dilatations. Conclusions: Primary repairs required less hopitalization and a shorter duration of indwelling catheters. In light of this experience the authors recommend a primary repair in patients with complete posterior urethral disruptions. J Pediatr Surg 37:1451-1455. Copyright 2002, Elsevier Science (USA). All rights reserved.

Re: Core-Through Urethrotomy Using The Neodymium:Yag Laser for Obliterative Urethral Strictures After Traumatic Urethral Disruption and/or Distraction Defects: Long-Term Outcome

Re: Core-Through Urethrotomy Using The Neodymium:Yag Laser for Obliterative Urethral Strictures After Traumatic Urethral Disruption and/or Distraction Defects: Long-Term Outcome

Evaluation and management of traumatic posterior urethral disruption with flexible cystourethroscopy.

We sought to consolidate evaluation and management of traumatic urethral disruption using cystourethroscopic evaluation without retrograde urethrogram or suprapubic cystostomy placement. We review our experience with initial flexible cystourethroscopic evaluation of suspected urethral injury from blunt trauma with placement of a Council urethral catheter to provide primary endoscopic realignment of the urethra. Access into the bladder was achieved in 8 of 10 patients. After a mean follow-up of 18 months (range, 9-27 months) in the six living patients, only three have required treatment for urethral stricture--direct vision internal urethrotomy in two, and open perineal urethroplasty in one. Urinary continence has been achieved in five of six patients. Primary flexible cystourethroscopy with placement of a urethral catheter streamlines evaluation of traumatic posterior urethral injury. In the presence of partial disruption it provided stricture-free outcomes in three of three surviving patients.

Traumatic urethral disruption: A protocol for diagnosis

Traumatic urethral disruption: A protocol for diagnosis

Traumatic Posterior Urethral Injury and Early Realignment Using Magnetic Urethral Catheters

Purpose We determined the success of early urethral realignment using magnetic urethral catheters. Materials and Methods We retrospectively reviewed the records of 13 patients with complete urethral disruption treated with endourological realignment 0 to 11 days after injury using coaxial magnetic urethral catheters. Results Urethral realignment was established in 11 of the 13 patients (85%) using magnetic urethral catheters. Of the 10 patients for whom followup was available urethral strictures developed in 5 (50%) a mean of 6.1 months after realignment, necessitating a mean of 1.4 corrective procedures per patient. Impotence was noted in 1 of 7 patients (14%) and no urinary incontinence developed after realignment. Conclusions Urethral realignment within 2 weeks of injury using magnetic urethral catheters is a safe and simple technique with minimal morbidity. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for delayed urethroplasty. We advocate early realignment using magnetic urethral sounds as an alternative treatment for traumatic urethral disruption.

Posttraumatic Posterior Urethral Strictures in Children: A 20-Year Experience

We attempted to identify the particular features of strictures complicating pelvic fracture urethral injuries in children. A total of 68 boys 3 to 15 years old who had sustained pelvic fracture urethral disruption underwent 78 urethroplasties performed by bulboprostatic anastomosis through the perineum in 42, transpubically in 23 and by 2-stage urethroscrotal inlay in 13. Perineal and transurethral urethroplasty was successful in 93 and 91% of cases respectively. There was a 54% failure rate after urethroscrotal inlay. Urethral strictures were most commonly associated with Malgaigne's fracture (35% of cases) and straddle fracture with or without diastasis of the sacroiliac joint (26%). Strictures were almost invariably inferior to the verumontanum with prostatic displacement in 44% of cases. Length of the strictured segment may be overestimated or underestimated on urethrography as a result of incomplete filling of the prostatic urethra or a urinoma cavity connected with the proximal segment, respectively. Perineal or transpubic bulboprostatic anastomosis is the best treatment for posttraumatic strictures, while internal urethrotomy should be avoided since it may compromise the chance of subsequent anastomotic urethroplasty. Repair of associated bladder neck incompetence may be deferred until the resumption of urethral voiding after urethroplasty, when incontinence can be documented.

外傷性尿道断裂による完全閉塞例に対する腔内穿刺による内視鏡的尿道再建術

We performed transluminal re-canalization by needle puncture under fluoro-endoscopic control on a total of ten patients (membranous urethra, 8; bulbous urethra, 2) with complete obliteration after traumatic urethral disruption. The re-canalized tract was created by balloon dilation, internal urethrotomy or endoscopic resection of the scar tissue. The patient age ranged from 10 to 57 years (mean age; 37.9 +/- 15.3 years). A transluminal puncture was attempted in three patients by transperineal-transurethral approach and in seven by transurethral approach. In one of them, who sustained a complete membranous disruption 5 weeks ago, transluminal puncture failed because of the movable proximal urethra. The remaining nine patients voided without difficulty for the mean follow-up period of 18.1 +/- 14.3 months (range: 2-46). Three patients had mild stress urinary incontinence. A transluminal puncture is less invasive, safe and reliable for re-establishment of the true proximal part of the disrupted urethra. It can be recommended as a useful technique for endo-urological re-establishment for a completely obliterated urethra. Although this endoscopic re-establishment requires urethral sounding or internal urethrotomy for 6 months postoperatively, it may be an alternative to conventional surgical repair.

Success of the Artificial Urinary Sphincter After Failed Surgery for Incontinence

We implanted the artificial urinary sphincter in 15 incontinent patients for whom multiple urethral and bladder neck operations, including sphincter placement, had been unsuccessful. The 5 male and 10 female patients ranged from 3 to 26 years old (mean age 11 years). The etiology of incontinence was neurogenic bladder in 10 patients, epispadias in 2, exstrophy in 1, ectopic ureters in 1 and traumatic urethral disruption in 1. Of the 15 patients 13 required augmentation enterocystoplasty and clean intermittent catheterization. The initial anti-incontinence procedures were Young-Dees-Leadbetter bladder neck reconstruction in 10 patients, artificial urinary sphincter placement in 4 and bladder neck suspension in 1. Causes of failure of the primary treatment were erosion (artificial urinary sphincter), and incontinence and/or difficult catheterization (Young- Dees-Leadbetter). Followup from the last salvage operation averaged 21 months (range 6 to 37 months). A total of 58 operations was performed. Among the 4 patients in whom the artificial urinary sphincter eroded the bladder neck repeated attempts to place the cuff at the same site were unsuccessful and erosion occurred in all 4 within 1 year. Sphincter placement was more successful among the 11 patients who initially underwent Young-Dees-Leadbetter bladder neck reconstruction or bladder neck suspension; acceptable continence was attained in 8 patients (73%).We conclude that placement of the sphincter cuff around a previously eroded bladder neck probably will result in erosion. Sphincter implantation should be attempted in patients in whom bladder neck reconstruction has failed. Persistence in the treatment of these patients is essential because multiple operations often are necessary to achieve continence. (J. Urol, 143: 987–990, 1990)

Treatment of urethral strictures with internal urethrotomy and 6 weeks of silastic catheter drainage.

No AccessJournal of Urology1 Feb 1974Treatment of Urethral Strictures With Internal Urethrotomy and 6 Weeks of Silastic Catheter Drainage Frank E. Carlton, Peter L. Scardino, and Robert B. Quattlebaum Frank E. CarltonFrank E. Carlton More articles by this author , Peter L. ScardinoPeter L. Scardino More articles by this author , and Robert B. QuattlebaumRobert B. Quattlebaum More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)59924-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1974 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKirchheim D, Tremann J and Ansell J (2018) Transurethral urethrotomy under visionJournal of Urology, VOL. 167, NO. 2 Part 2, (1097-1100), Online publication date: 1-Feb-2002.DOGRA P and NABI G (2018) CORE-THROUGH URETHROTOMY USING THE NEODYMIUM: YAG LASER FOR OBLITERATIVE URETHRAL STRICTURES AFTER TRAUMATIC URETHRAL DISRUPTION AND/OR DISTRACTION DEFECTS: LONG-TERM OUTCOMEJournal of Urology, VOL. 167, NO. 2 Part 1, (543-546), Online publication date: 1-Feb-2002.Roehrborn C and McConnell J (2018) Analysis of Factors Contributing to Success or Failure of 1-Stage Urethroplasty for Urethral Stricture DiseaseJournal of Urology, VOL. 151, NO. 4, (869-874), Online publication date: 1-Apr-1994.Engel R (2018) Editorial CommentJournal of Urology, VOL. 127, NO. 4, (676-676), Online publication date: 1-Apr-1982.Fair W (2018) Internal Urethrotomy Without a Catheter: Use of a Urethral StentJournal of Urology, VOL. 127, NO. 4, (675-676), Online publication date: 1-Apr-1982.Zinman L (2018) Editorial CommentJournal of Urology, VOL. 127, NO. 3, (435-435), Online publication date: 1-Mar-1982.Gibod L and Le portz B (2018) Endoscopic Urethrotomy: Does it Live Up to its Promises?Journal of Urology, VOL. 127, NO. 3, (433-435), Online publication date: 1-Mar-1982.Konnak J and Kogan B (2018) Otis Internal Urethrotomy in the Treatment of Urethral Stricture DiseaseJournal of Urology, VOL. 124, NO. 3, (356-357), Online publication date: 1-Sep-1980.Engel R (2018) Editorial CommentJournal of Urology, VOL. 121, NO. 1, (46-46), Online publication date: 1-Jan-1979.Kinder P and Rous S (2018) The Treatment of Urethral Stricture Disease by Internal Urethrotomy: A Clinical ReviewJournal of Urology, VOL. 121, NO. 1, (45-46), Online publication date: 1-Jan-1979.Kirchheim D, Tremann J and Ansell J (2018) Transurethral Urethrotomy Under VisionJournal of Urology, VOL. 119, NO. 4, (496-499), Online publication date: 1-Apr-1978. Volume 111Issue 2February 1974Page: 191-193 Advertisement Copyright & Permissions© 1974 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Frank E. Carlton More articles by this author Peter L. Scardino More articles by this author Robert B. Quattlebaum More articles by this author Expand All Advertisement PDF downloadLoading ...