Urethral Injury Research Articles

Vessel-sparing non-transecting anastomotic reconstruction of the posterior urethra: Single center experience with long-term follow-up

OBJECTIVETo discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future. METHODSThe bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and perform the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries. RESULTS127 patients, median age 58 years (IQR 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n=48), pelvic fracture urethral injury (PFUI) (n=61), prostate cancer treatment (n=14) and instrumentation (n=4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. 14 patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow up of 36 months, CONCLUSIONSparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future.

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

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

Constructing Mg-phytic acid enhanced hydrogel patch with janus structure for antibacterial and angiogenic urethral repair

Due to bacteria in urine and inadequate blood supply, urethral defect repair faces great clinical difficulties. Inspired by the natural structure of the urethra, in this study, we designed a multifunctional hydrogel urethral patch with a Janus structure. The inner layer was a double-network hydrogel of polyvinyl alcohol/carboxymethyl chitosan (PVA/CMCS) enhanced by natural phytic acid (PA) and Mg2+ (Mg2+-PA/PVA/CMCS). The outer layer was composed of poly (L-lactic acid) (PLLA) nanofibers to form a hydrophobic barrier, coupling via a micelle layer to ensure interfacial bonding. The patch exhibited mechanical properties matching soft tissues, with maximum tensile strength and toughness of 1.69±0.13 MPa and 24.7±0.9 MJ/m3, respectively, under the strengthening effect of Mg2+-PA chelation. Therein, the 4 % Mg2+-PA/PVA/CMCS composite patch could maintain unilateral hydrophobicity for at least 14 days and demonstrated an antibacterial rate of 99.0 %±0.1 % against E. coli. In PBS, the patch could deliver Mg2+ for at least 7 days and stabilize the surrounding pH environment for up to 28 days. In vitro cell experiments indicated that the 4 % Mg2+-PA/PVA/CMCS composite patch could promote the human umbilical vein endothelial cell (HUVEC) proliferation and migration, with the angiogenic protein expression enhanced more than 1.2 times compared with the Control group. In conclusion, the patch constructed in this study may provide a new approach to clinical urethral injury repair.

Consumer product-related female genital injuries in the USA from 2013 to 2022

BackgroundConsumer product-related genital injuries in females across all age groups are understudied. Existing research focuses primarily on paediatric populations. We aimed to determine characteristics, trends and predictors of hospitalisation.MethodsThe National...

Implementation of a Standardized Process of Coude Catheter Insertion Decreases Traumatic Catheterizations

ObjectiveTo address the issue of traumatic foley catheterization we developed and implemented a coude catheter education program for operating room nurses as well as standardize the usage of a coude catheter for male patients. Traumatic catheterization leads to patient morbidity and increased healthcare costs. MethodsA retrospective review was conducted to identify all traumatic catherizations over a 6-month period for several surgical services at our institution. A nursing education program was implemented that included basic urological anatomy, coude urethral catheter insertion techniques, and catheter safety. We conducted our trial over a period of 2-months with all catheterizations tracked. Following the trial, the process and outcomes were reviewed and then implemented for all male patients >18 years old requiring indwelling catheter placement in the operating room. ResultsOn retrospective review there were 18 traumatic foley catheterizations of patients on the three surgical services out of a total 601 catheter placements (3% traumatic placement rate). The total cost of these traumatic catherizations was $27,793 when accounting for additional procedures, supplies, and additional OR time required for each traumatic catheterization. The average cost per patient was $1,544. After full implementation of the process across all operating room services in June 2021 there have been 2038 catheterizations performed using a coude catheter kit with 4 traumatic foley placements through May 2022 (0.2% traumatic catheterization rate). ConclusionImplementation of the nursing education program and utilization of the coude catheter for all male catheterizations reduces costs, decreases iatrogenic urethral injury, and improves patient safety.

Precise treatment of pelvic fracture urethral injury associated with urethrorectal fistula.

To evaluate the effect of a new strategy of transperineal anastomotic urethroplasty (TAU) with proximal transection in treating pelvic fracture urethral injury (PFUI) associated with urethrorectal fistula (URF). A retrospective review of all patients treated by TAU with proximal transection and fistula repair for PFUI associated with URF was performed between August 2013 and July 2022. Information on demographics, peri-operative variables, and postoperative follow-up outcomes was collected. Successful surgery was defined as restoration of a uniform urethral calibre using flexible cystoscopy (third postoperative month) without strictures or leakage, with no further interventions required. Functional outcomes, including erectile function (assessed using the five-item International Index of Erectile Function) and urinary continence, were assessed. Forty patients diagnosed with PFUI associated with URF and treated by TAU with proximal transection and rectal fistula repair were enrolled. Six patients (15.0%) had a history of failed urethral reconstruction. The mean stenosis length and fistula diameter were 2.9 cm and 1.2 cm, respectively. All patients underwent faecal diversion before urethroplasty. After a median (range) follow-up of 45 (3-115) months, the final success rate was 90.0% (36/40). Postoperative complications included haematoma in three patients, epididymo-orchitis in three, wound infection in one, wound bleeding in one, delayed wound healing in three, and wound numbness in three. The overall incidence of postoperative erectile dysfunction reached 75.0%, with a median (range) score of 9 (0-19). Normal continence was achieved in 31 patients (77.5%). Occasional incontinence without the need for urinal pads occurred in eight patients, whereas one patient required urinal pads. Transperineal anastomotic urethroplasty with proximal transection is a precise and effective surgical strategy for treating PFUI associated with URF. This strategy ensures a high success rate and improves surgical efficiency.

Применение большого количества методов оперативного лечения стриктуры уретры у одного пациента: клинический случай

Introduction. Insufficient surgical experience and inadequate choice of surgical treatment options may be the reasons for the failure of treatment of urethral stricture. In this regard, a clinical case from our practice is very indicative. Case: The article is devoted to the description of a clinical case of urethral injury in a man who, at the age of 22 years, suffered a fracture of the pelvic bones as a result of a traffic accident. From the moment of injury to the final operation, the following types of surgical interventions were sequentially performed in this patient: anastomotic endto-end urethroplasty, augmentation urethroplasty using a skin graft, augmentation urethroplasty using a graft of the tunica vaginalis of the testicle, bougienage of the urethra, urethroplasty with a vascularized radial fasciocutaneous flap on a vascular pedicle, 2-stage urethroplasty using a graft of the buccal mucosa according to the type of Bracka I and II operations, perineal urethrostomy. Urethrostomy became the final option for urine diversion; no recurrence of urethral stricture was observed during 4 years of follow-up after urethrostomy. Conclusion. Until recently, the lack of uniform approaches to the treatment of urethral stricture has led to the use of inadequate methods of surgical treatment in various clinics. The recent approval of federal clinical guidelines for urethral stricture should help optimize the treatment of this disease. Keywords: urethral stricture, urethroplasty, urethrostomy

Successful management of a combined penile and urethral fracture.

This case highlights a rare occurrence of combined penile fracture and urethral injury in a 35-year-old male, emphasizing the critical need for accurate diagnosis and precise surgical intervention in such cases. After a mishap during sexual intercourse, the patient faced intense penile pain, swelling, and urethrorrhagia. Advanced diagnostic methods, particularly MRI, confirmed a disruption in the tunica albuginea within the left corpora cavernosa. The patient underwent emergent surgical repair, addressing both urethral and corpora cavernosa injuries, leading to a successful postoperative course. This case report underscores the paramount importance of comprehending and effectively managing complex urological traumas. Timely and appropriate surgical intervention is crucial for ensuring optimal patient recovery and well-being in instances of combined penile and urethral injuries.

A novel technique for atraumatic transurethral catheterisation of male rats.

Transurethral catheterisation of male rats is technically difficult owing to anatomical peculiarities. In the male rat, the urethral striated sphincter consists of two lateral fascicles separated by an anterior and a posterior strip of connective tissue, which impedes the smooth insertion of a urinary catheter. For rat studies requiring continuous collection of urine, bladder irrigation, or measurement of bladder pressure, investigators either have to exclude the male population (be limited to the female population) or perform percutaneous (suprapubic) bladder puncture in male rats, which is more traumatic and invasive than transurethral catheterisation. This paper describes a novel, atraumatic method of transurethral catheterisation in the male rat, with the aid of a microscope and microsurgical instruments. Six Wistar rats were used for this experiment, all of which were catheterised successfully, with no evidence of bladder or urethral injury. The study shows that male rats can be safely catheterised via the urethra with the aid of a microscope and microsurgical instruments for both visual and tactile feedback. This is a relatively straightforward technique to learn and can allow for inclusion of male rats in future studies requiring urinary analysis or bladder irrigation, without the need for traumatic percutaneous (suprapubic) bladder puncture.

Surgical outcomes in penile fractures: A single center experience in China

IntroductionPenile fracture is an uncommon urological emergency resulting from tunica albuginea rupture during penile erection. It is a rare condition requiring urgent surgery. Despite immediate surgical repair, the patients' erectile functions may still be impacted by penile fracture. This study aims to investigate the efficacy of surgical repair in penile fractures and its impact on erectile function. MethodsOur cohort was composed of patients diagnosed with penile fractures and received surgical repair from September 2014 to August 2022 in Peking University First Hospital. Penile color Doppler ultrasound confirmed the diagnosis. Surgical exploration was conducted, and postoperative complications were evaluated during follow-up. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) score. Univariate analysis was conducted employing the chi-square test, t-test, and Mann-Whitney U test to identify factors that may impact postoperative erectile function. Furthermore, multivariate analysis was conducted using logistic regression and linear regression to determine the independent risk factors influencing postoperative erectile function. ResultsA total of 58 patients were enrolled in our study. The majority of injuries (69.0 %, 40/58) resulted from vigorous sexual intercourse. Most of the patients (69.0 %, 40/58) presented within 24 h. Sixteen patients (27.6 %) presented with concomitant urethral injury. The median size of the tunical tear was 1.5 (IQR, 1.0–2.0) cm. Presentation delay correlated significantly with the difference in IIEF-5 score before and after surgery, with corresponding p values of 0.028. Urethral injury correlated significantly with postoperative erectile dysfunction (ED), postoperative IIEF-5 score, and the difference in IIEF-5 score before and after surgery, with corresponding p values of 0.002, 0.004, and 0.002, respectively. ConclusionsTo conclude, surgical repair of penile fracture provides good functional results with few morbidities and urethral injury may adversely affect postoperative erectile function after penile fracture repair.

Management of Complications of Prosthetic Mid-urethral Tape Surgery for Stress Urinary Incontinence in Women

OBJECTIVESto propose guidelines for the management of complications of prosthetic mid-urethral tape surgery for stress urinary incontinence in women. METHODSThese guidelines are based on an exhaustive literature review on retropubic and trans-obturator mid-urethral tape complications. The expert panel rated the level of evidence of each study, summarized literature for the treatment of each complication, and proposed guidelines. RESULTSManagement of these complications is complex and the first treatment is crucial to offer the best functional result to the patient. We propose a standardized approach and guidelines for the management of complications to help physicians to early identify a surgical complication, offer adequate treatment for each complication and provide clear and appropriate information to patients. We detailed management of intraoperative complications: bladder, urethral, vaginal, visceral and vascular injury; short term post-operative complications: bleeding/hematoma, voiding dysfunction, pain, infection; and long-term post-operative complications: chronic voiding dysfunction, de novo overactive bladder syndrome, chronic pain, dyspareunia, vaginal, bladder and urethral tape erosion. CONCLUSIONThese guidelines may help physicians to improve management of prosthetic mid-urethral sling complications that may occur following stress urinary incontinence surgery.

Imaging Findings Associated With Failure of Conservative Management After Blunt Extraperitoneal Bladder Injury

ObjectivesTo identify risk factors for failure of conservative management (CM) for uncomplicated extraperitoneal bladder injuries (EBI). MethodsThe trauma registry at a single Level 1 trauma center was queried for patients presenting with a blunt EBI between 2004 and 2022. Patients with CM and follow-up through at least one postoperative cystogram or catheter removal were included. A univariable analysis for associations with a composite outcome of either persistent leakage or delayed cystorrhaphy was completed. ResultsEighty-four patients with an EBI underwent CM. Seventy-eight (93%) patients had an associated pelvic fracture and 17 of 84 (20%) underwent embolization for pelvic hemorrhage. Thirty-four (41%) patients also had delayed phase imaging, 17 (20%) of whom had extravasation from their bladder on delays. Six (7%) patients failed initial CM. There was no association between the composite outcome and pelvic fracture (p=0.35) or embolization (p=0.41). American Association for the Surgery of Trauma (AAST) grade 5 injuries (p=0.01) and the presence of extravasation on delayed-phase Computed Tomography (p=0.03) were associated with the composite outcome. ConclusionsContrast extravasation on initial delayed-phase imaging despite urethral catheter drainage and AAST injury grade were associated with failed CM after EBI. This may reflect injuries that mechanistically yield incomplete antegrade drainage with CM.

Validation Study of the LSE Classification and Scoring System in Comparison With U-Score

OBJECTIVETo validate the value of the LSE classification and scoring system in predicting surgical outcomes for male anterior urethral stricture cases. METHODSA retrospective review was conducted on 566 patients who underwent urethroplasty between August 2004 and March 2022. After excluding pelvic fracture urethral injury and non-stricture diseases and incomplete data, 358 patients were classified according to the LSE classification system, and both U score and LSE score were calculated. We investigated the relationship between LSE score and U score in predicting recurrence. Recurrence was defined as any instance requiring re-intervention. To identify factors contributing to recurrence, logistic regression analysis was performed on the LSE score and variables not included in the scoring system. RESULTSThe breakdown of S, and E components showed external trauma as the most common cause of strictures, with proximal bulbar urethra being the most common segment. Significant associations were observed between stricture etiology and segment, as well as between surgical technique and segment. A strong correlation (r = 0.73) was found between U score and LSE score, with no significant difference in predicting recurrence between the two scores. Surgical complexity differed significantly between LSE score groups, but surgical duration did not. Patients with LSE < 7 showed a better recurrence rate in Kaplan-Meier analysis. Multivariate logistic analysis identified LSE ≥ 7 as an independent risk factor for recurrence. CONCLUSIONThe LSE classification system and scoring system demonstrate validity in characterizing anterior urethral strictures and predicting surgical outcomes.

Optimised Protocol for Managing Failed Catheterisation: Leveraging Bedside Retrograde Urethrography and Cystourethroscopy.

Introduction Urethral catheterization is a routine procedure often required for many hospitalized patients. Various conditions, such as meatal stenosis, stricture urethra, false passage, benign prostatic hyperplasia, bladder neck contractures, and impacted urethral stones, can contribute to difficulty in catheterisation. In the setting of failed attempts at per urethral catheter placement, the subsequent intervention is suprapubic catheter (SPC) insertion. SPC placement has its associated complications and causes inconvenience to the patients. We framed an algorithm to minimise the need for SPC insertion in cases of difficult per urethral catheterisation in a non-trauma setting. This study aimed to evaluate the common causes of difficult per urethral catheterisation and establish the efficacy of our algorithm in managing difficult catheterisation with bedside retrograde urethrography (RGU) and cystoscopy while avoiding SPC placement. Materials and methods This prospective observational study was conducted from September 2022 to June 2024. Patients admitted with urinary retention or requiring routine catheterisation, with one failed attempt at catheterisation, were included in the study. Our algorithm for the management of difficult catheterisation in a non-trauma setting, to avoid SPC, integrates a bedside RGUand retrograde urethroscopy using either a 15.5 Fr cystoscope sheath or a 6 Fr ureteroscope to identify the urethral pathology, followed by dilatation and per urethral catheterisation. Results Among 55 patients (aged 34-82 years), 48 (87.27%) were male and seven (12.73%) were female. The most common indication for catheterisation was routine catheterisation for output monitoring (n = 30; 54.54%), followed by acute retention (n = 25; 45.45%). Bulbar urethral stricture (n = 28; 50.9%) was the most common cause of difficult catheterisation, followed by meatal/sub-meatal narrowing (n = 13; 23.63%), enlarged prostate or high bladder neck (n = 4; 7.27%), and impacted stones (n = 3; 5.45%). Successful catheterisation was achieved in 48 male patients following urethroscopy with a 6 Fr ureteroscope or 15.5 Fr cystoscope. In females, reducing the pelvic organ prolapse enabled catheterisation in two cases, while five required serial dilatation and catheterisation. Successful per-urethral catheterisation was achieved in all 55 (100%) patients, thus avoiding SPC. Conclusions Conventional blind catheterisation techniques have limited success in the setting of failed initial catheterisation. This approach, which employs bedside fluoroscopy and direct visualisation of the urethra using a cystoscope or ureteroscope, helped achieve higher success rates (n = 55; 100%) for difficult per-urethral catheterisation and avoided the need for SPC. Proper implementation of this protocol for dealing with difficult per-urethral catheterisation will reduce the unnecessary burden on the healthcare system by minimising the potential iatrogenic urethral injuries and reducing the need for SPC.

Repair of a Severe Penile Fracture and Associated Urethral Injury

Repair of a Severe Penile Fracture and Associated Urethral Injury

Features of treatment of posterior urethral injuries in the acute period of traumatic disease

BACKGROUND: Combined pelvic trauma in men in 10%–24% of cases is accompanied by damage to the posterior urethra, and no consensus on the treatment tactics has been established for such patients. AIM: This study aimed to evaluate the results of treatment of patients with closed injury of the posterior urethra and traumatic shock. MATERIALS AND METHODS: A retrospective analysis of the results of treatment of 46 patients with closed injury of the posterior urethra caused by a fracture of the pelvic bones and traumatic shock was performed. The average age of patients was 42.1 ± 9.9 years. The severity of urethral injuries was assessed according to the American Association for the Surgery of Trauma (AAST) classification. RESULTS: The choice of treatment techniques depended on the degree of damage to the urethra and severity of traumatic shock. Upon hospital admission, 15 (32.6%) patients were diagnosed with grade I, 21 (45.6%) with grade II, and 10 (21.7%) with grade III traumatic shock. In grade I–II traumatic shock patients with incomplete urethral rupture, a urethral catheter was inserted, followed by conservative therapy. If a catheter insertion was possible, a retropubic revision of the urethra was performed. Patients with grade III–V urethral injury according to AAST and grade I–II traumatic shock underwent primary or delayed urethroplasty, such as urethral suturing and urethra-urethral anastomosis. Patients with grade III traumatic shock had a urethral catheter or cystostomy. In the long-term, 6 of 17 (36.9%) patients who underwent primary or delayed urethroplasty had short-term (up to 5 mm) urethral strictures, for which optical urethrotomy was performed. All patients with complete urethral avulsion who did not undergo early urethroplasty developed 10–20 mm strictures, requiring reconstructive surgery. CONCLUSIONS: The choice of treatment techniques for patients with concomitant damage to the posterior urethra depends on the degree of damage to the urethra and severity of traumatic shock. The scope of treatment in the acute period may include urethral or suprapubic drainage of the bladder or reconstructive surgery.

Urologic Trauma Management for Military Providers.

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

Experience of the Early Penile Fracture Repair: A Cross-Sectional Study in A Tertiary Care Center

Background: Penile fracture is a surgical emergency and most often it can be diagnosed clinically. But delayed presentation due to the embarrassing nature of the injury makes surgical outcome worse. Objectives: This study was conducted to compare results of early and delayed surgical interventions of patients presenting with penile fracture. Methodology: A cross-sectional study was conducted at the department of Urology, in Dhaka Medical College of hospital, Bangladesh from 30th July 2018 to 30th January 2020. Twenty- Seven (27) patients with penile fracture were enrolled in this study. They were diagnosed on the basis of history and clinical findings. They were divided into two groups; early presenter (15 patients) who came within 24 hours and delayed presenter (12 patients) who came after 24 hours. Among the early presenters, 13 patients had unilateral corporeal injury and 2 patients had bilateral corporeal injury. On the other hand, in delayed presenters, 11 patients had unilateral corporeal injury and 1 patient had bilateral corporeal injury. Surgical repair was done in all patients. Results: Patient age range was between 15 to 60 years. The commonest presenting complaints were cracking sound 26 out of 27 (96.30%), penile swelling 24 out of 27 (88.88%), pain 22 out of 27(81.48%) and detumusence during sexual intercourse or an erection 17 out of 27(62.96%), urethra bleeding 3 out 27(11.1%). Among different causes, vigorous intercourse where female on top (62.9%) was the commonest followed by bending during erection (18.5%), masturbation (11.1%) And rolling over bed (7.4%). Out of 15 patients in early group, patients presented with urethral injury. The complications in delayed repair group were, plaque formation 3 out of 15 (20%); penile shaft deformity 2(13.3%); erectile dysfunction 1(6.6%) and skin necrosis 2 (13.3%). But in early repair group only one patient developed skin necrosis which was managed conservatively. Conclusion: Fracture of the penis is a surgical emergency. Immediate surgical repair gives excellent results even in the presence of urethral injury. Early diagnosis by history and clinical examination and timely surgical intervention is essential for better outcome with minimal longterm complications. J Dhaka Med Coll. 2022; 31(2) : 210-214

Case Report: Management of Penile Fracture with Urethral Injury in Two Patients

Penile fracture is a trauma accompanied by sudden pain, swelling, loss of erection, deviation, and ecchymosis along with a breaking sound in the penis. It can be accompanied by urethral injuries in 11-22% of patients, occurring due to force/blunt trauma to the erect penis. In this case report, we present two cases of penile fracture with accompanying urethral injury, occurring approximately one month apart. In our first case, surgical repair was performed approximately 1 hour after the incident, and in the second case, it was performed approximately 2 hours after the incident. Ultrasound (USG) was used as radiological imaging in both cases. In the second case, suspicion of urethral injury was mentioned in the USG. In both cases, a subcoronal circumferential incision was made, and the penile skin was degloved up to the radix. Damaged areas in the intraoperative tunica albuginea and urethra were observed in both cases. Postoperatively, the penile bandage of the first case was removed on the 4th day, and that of the second case was removed on the 6th day. The catheter was removed on the 20th day in both cases. In both cases, no loss of erection or penile deviation was observed at the 3-month postoperative follow-up. No clinical or uroflowmetric findings compatible with urethral stenosis were found in the 2nd and 3rd months post-op. The current approach to penile fractures is emergency surgical decompression and repair.

Comparison of erectile and ejaculatory functional outcomes between unilateral and bilateral cavernosal rupture in penile fractures

This study aimed to compare the erectile and ejaculatory functional outcomes of unilateral and bilateral ruptures of the corpus cavernosum in penile fractures. Sixty patients’ data were analyzed retrospectively between June 2020 and January 2023. The patients were divided into two groups based on the affected corpus cavernosum (unilateral and bilateral). Preoperative and postoperative 3rd-, 6th-, and 12th-month self-estimated intravaginal-ejaculation-latency-time (IELT), and international index of erectile function-erectile function (IIEF-EF) scores as well as the presence of urethral injury were compared. Bilateral corpus cavernosum fractures were detected in 18.3% of the patients. The IIEF-EF scores of both groups at 3rd-, 6th-, and 12th-month were found to be significantly lower than the preoperative scores (unilateral group:24.1 ± 2.7 vs 23.2 ± 3.5 and 23.3 ± 3.4, respectively, p = 0.011 and 0.014, respectively; bilateral group: 24 ± 1.9 vs 23 ± 1.8 and 23.2 ± 1.5, respectively, p = 0.027 and 0.047, respectively). No significant difference was found between the preoperative and the postoperative 12th month IIEF-EF scores in either group (unilateral group: 24.1 ± 2.7 vs 23.4 ± 3.6, p = 0.207;bilateral group:24 ± 1.9 vs 23.2 ± 1.5, p = 0.057). The self-estimated IELTs of both groups at the postoperative 3rd, 6th, and 12th months demonstrated a significant increase from the preoperative values (unilateral group: 221.6 ± 81.8 vs 252 ± 94.6, 256.5 ± 97.6, and 250.5 ± 104.8, respectively, p < 0.001; bilateral group:241.8 ± 61.6 vs 278.1 ± 55.4, 281.8 ± 56.1, and 283.6 ± 54.2, respectively, p = 0.041, 0.030, and 0.047, respectively). The changes in self-estimated IELTs and IIEF-EF scores between the preoperative period and the postoperative 3rd, 6th, and 12th-months were compared, and no statistical difference was found between patients with unilateral and bilateral corpus cavernosum fractures (p > 0.05). In conclusion, no significant difference in erectile function was found in either group at the 12-month follow-up, and the self-estimated IELTs were found to be prolonged in both groups. Furthermore, no difference was noted between the groups at any follow-up. To explain the effects of unilateral and bilateral injuries on erectile and ejaculatory functions, further studies with a larger-number of patients are necessary.