Urethral Realignment Research Articles

Editorial Comment on the article titled "Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized controlled trial".

Editorial Comment on the article titled "Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized controlled trial".

Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized controlled trial.

To assess the efficacy of primary urethral realignment in the prevention of urethral stenosis and in simplifying delayed urethroplasty after complete pelvic fracture urethral injury in male children. This randomized comparative trial included 40 boys <18 years with complete pelvic fracture urethral injury. The initial management was a primary urethral realignment in 20 boys and suprapubic cystostomy alone in the remaining 20 boys. The boys who underwent primary urethral realignment were assessed regarding thedevelopment of urethral stenosis. Boys who needed to be delayed urethroplasty in the two groups were compared regarding urethral defect length, intraoperative details, postoperative outcomes, number of procedures, and time to achieve normal voiding. Although 14 (70%) patients were able to void after primary urethral realignment, all of them developed urethral stenosis and needed delayed urethroplasty. No statistically significant difference between the two groups was found regarding urethral defect length, intraoperative details, and postoperative outcomes. Patients in the primary urethral realignment group underwent significantly more procedures (p < 0.001) and took a significantly longer time to achieve normal voiding (p = 0.002). Primary urethral realignment is neither able to prevent urethral stenosis nor effective in simplifying later urethroplasty after complete pelvic fracture urethral injury in male children. It exposes the patients to more surgical procedures and a prolonged clinical course.

A FOUR-YEAR FORGOTTEN URINARY CATHETER IN A SEXUALLY ACTIVE YOUNG MALE AND ITS MANAGEMENT: A CASE REPORT

The urinary catheters’ mean indwelled duration after PIUR (primary interventional urethral realignment) is 25 days. Only four cases of forgotten urinary catheter were reported in the literature. The objective of this clinical case report is to highlight the unusual finding of a four-years forgotten urinary catheter in a young sexually active 23-year-old man and its management, aspiring future similar endeavors. A 23-year-old man presented to the hospital exhibiting severe supra-pubic pain and inability to urinate for one day. He described undergoing PIUR for a traumatic urethral rupture four years ago. An indwelling urinary catheter was placed subsequently, that he claims being removed by his physician 21 days later. Urinary hesitancy and frequency were reported since then, maintaining normal sexual activity. Based on having a tender vesicular globe, and a disclosed rod inside his penis, he was diagnosed with urinary retention by a foreign body and admitted to the hospital for further investigations. Vesicular decompression by a supra-pubic catheter was performed. A non-contrast pelvic CT scan revealed a calcified elongated structure suspecting an encrusted retained urinary catheter. In the operating room, rigid ureteroscope with the assistance of lithotripsy were proficient in fragmenting only intra-urethral calcifications. Sequentially, an open cystolithotomy evacuated the remaining calcified vesicular balloon. Patient was asymptomatic on subsequent visits denying any urinary symptoms and stating normal sexual activity. Removing such a foreign body, especially when severely encrusted as well as avoiding trauma to the urethra while minimizing patient morbidity remain a clinical confront for the surgeon. Hence, minimally invasive procedures are always preferred. In this case, we had to assist the rigid ureteroscope and the lithotripsy by an open cystolithotomy for the large calcified balloon. Nevertheless, this method has proved to be safe and efficient. Thus, it is suggested to be used in future comparable cases.

Repair of Traumatic Urethral Strictures: La Paz University Hospital Experience

The management of traumatic urethral strictures remains a challenge for urologists. Alteration of the pelvic anatomy and the significant fibrosis generated by the trauma make surgical repair complex. In most cases, the existing defect between the urethral ends is small, and the ideal treatment is end-to-end perineal urethroplasty. Cases of extensive strictures that are left with long gap defects may require the use of different sequential maneuvers to achieve a tension-free anastomosis. To describe the experience at our center with urethral strictures induced by closed perineal trauma. A retrospective analysis of 116 patients who underwent urethroplasty for urethral stricture after blunt perineal trauma at our center between 1965 and 2020 was conducted. Demographic data, date, mechanism of action of the trauma, emergency management, previous urethral interventions, surgical technique carried out in our center, complications, presence of erectile dysfunction, and urinary incontinence were collected. 82 patients (70.7%) presented with pelvic fractures. The most frequent etiology of trauma was traffic accidents (68%), followed by crushing injuries (24%). Suprapubic cystostomy was placed in 50.2% of patients, and urethral realignment was performed in 25.3%. The mean stricture length was 2.2 cm, affecting mostly the membranous urethra (67%). During surgery, it was necessary to perform crural separation in 61.5% and partial pubectomy in 18.8% of the cases. Erectile dysfunction developed after trauma in 40.5% of cases, while new erectile dysfunction was noted in 4.3% of patients after surgery. Surgery was successful in 91.3% of cases, with a median follow-up of 16 (6-47) months. Delayed anastomotic urethroplasty offers a high success rate in traumatic urethral strictures.

Contemporary management of pelvic fracture urethral injuries

Posterior urethral injuries in men usually result from polytrauma with pelvic fractures and severe associated injuries. If left untreated, posterior urethral injury can lead to severe complications and even death, so precise diagnosis should be made when urethral injury is suspected. The cardinal symptom of urethral injury is blood leakage from the meatus. Retrograde urethrography is the diagnostic tool of choice. In the case of complete urethral avulsion, the formation of aurethral stricture due to pronounced scarring fibrosis is inevitable. In principle, various therapeutic approaches are available. Often, urinary diversion by means of atransurethral or suprapubic catheter is performed first. However, there is also the possibility of direct endoscopic or open urethral realignment with subsequent temporary catheterization. Immediate surgical reconstruction is useful only in exceptional cases of simultaneous bladder neck or rectal injury. In cases of complete urethral avulsion, secondary transperineal bulboprostatic reanastomosis at the interval after three months of suprapubic continuous drainage with excellent success rate is the gold standard and can be supplemented with ancillary maneuvers if necessary to ensure atension-free anastomosis.

A novel stricture prevention technique in blunt urethral injury: A multi-center retrospective observational study.

PurposeBulbar injury is the most common type of urethral injury. This study investigated the efficacy and safety of a novel technique, local urethral flushing, in preventing stricture formation after blunt bulbar urethra injuries.Materials and MethodsThis retrospective study included 205 males diagnosed with straddle injury-induced bulbar urethra injury at the Shanxi Bethune Hospital and First Hospital of Shanxi Medical University between January 2015 and January 2019. Patients were diagnosed by retrograde urethrography and classified as partial or complete urethral rupture according to the urethral integrity after injury. Complete urethral rupture patients received suprapubic cystostomy and received urethroplasty 3 months later. Patients with partial urethral rupture underwent endoscopic urethral realignment by cystoscopic guide-wire guided catheterization. Patients with both injury types were divided into 3 groups. The treatment groups received urethral flushing with 0.05% dexamethasone through a secondary ureteral catheter that locked at the urethral lesion. The blank control groups received normal saline. The negative control groups had only a single ureteral catheter placed. Patients were assessed for pain during catheterization, infection, and stenosis, and followed for at least 2 years.ResultsStenosis rates and length were significantly reduced in the normal saline groups, and even further reduced in the dexamethasone groups. The negative control groups had significantly higher infection rates than patients in the dexamethasone or saline groups.ConclusionsLocal urethral flushing with dexamethasone could significantly decrease urethral stenosis rates and severity without increasing patients’ discomfort or infection risk.

PD31-01 A MULTI-CENTER PROSPECTIVE COHORT STUDY OF ENDOSCOPIC URETHRAL REALIGNMENT VERSUS SUPRAPUBIC CYSTOSTOMY AFTER PELVIC FRACTURE URETHRAL INJURY

INTRODUCTION AND OBJECTIVE:Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. In management of PFUI, there is mixed evidence supporting endoscopic urethral realignment ...

Complete Posterior Urethral Disruption Accompanied by Complex Pelvic Fractures: Clinical Outcomes of Fluoroscopic Primary Posterior Urethral Realignment

PurposeTo evaluate the clinical outcomes of fluoroscopic primary posterior urethral realignment (PPUR) for complete posterior urethral disruption (PUD) accompanied by complex pelvic fractures. Materials and MethodsData from 15 male patients (median age, 58 years; range, 32–76 years) with traumatic PUD treated with fluoroscopic PPUR between 2016 and 2019 at a regional trauma center were retrospectively analyzed. The technical success (continuity of the ruptured urethra in PUD by Foley catheter placement) rate of fluoroscopic PPUR, trauma mechanism, concurrent embolization for pelvic arterial hemorrhage, time from the hospital visit to the start of the procedure, procedure time, Foley catheterization duration, and delayed complications were investigated. ResultsFluoroscopic PPUR was technically successful for 13 of 15 (87%) patients. Concurrent embolization for pelvic arterial hemorrhage was performed in 11 of 15 (73%) patients. The mean time between the hospital visit and procedure initiation was 181.6 minutes ± 83.2. The mean procedure time was 66.3 minutes ± 26.6. The mean Foley catheterization duration for 13 patients (technical success group) was 52.3 days ± 39.8 (median, 40 days; range, 21–177 days). Symptomatic urethral stricture developed in 9 of 13 (69.2%) patients after the procedure; 7 underwent visual internal urethrotomy, 4 required regular urethral dilatation, and 2 needed urethral stent insertion. Three of 13 (23%) patients did not have delayed complications during the 1-year follow-up. ConclusionsPPUR with fluoroscopic guidance appears safe and effective for achieving the continuity of the ruptured urethra in PUD. It enables PPUR without general anesthesia and the lithotomy position in patients with complex pelvic fractures.

Bladder neck reconstruction in girls\u2019 pelvic fracture bladder neck avulsion and urethral rupture

BackgroundGirls’ pelvic fracture bladder neck avulsion and urethral rupture is rare however it causes great morbidity. The management is complex and not standard yet. We report our experience and a technique of bladder neck reconstruction with anterior bladder wall flap.MethodsWe retrospectively analysed data of 5 girls with pelvic fracture bladder neck avulsion and urethral rupture admitted to our institution from July 2017 to October 2019. They all came to our institution with a suprapubic tube. Patients’ trauma was all initially treated at other hospitals, 4 had suprapubic cystotomy and 1 had urethral realignment. One girl also had three other urethroplasties at other hospitals. We took pubectomy, posterior urethroplasty and bladder neck reconstruction with anterior bladder wall flap in these 5 girls. Post-operative assessments included voiding cystourethrography, uroflowmetry and urethroscopy after urethral catheter removal. Verbal consent to participate was obtained from the parent or legal guardian of the children.ResultsOperation time ranged from 120 to 180 min. Follow-up time is 12 to 27 months. Uroflowmetry showed that maximum urine flow rate improved significantly. Cystourethrography indicated good continuity of the urethra. Two girls had urinary incontinence postoperatively but were continent 3 months later. One patient developed vesical-abdominal fistula and got repaired by surgery 6 months later. She was continent ever since. Other complications were not observed during the follow-up period.ConclusionsOur method of bladder neck reconstruction using bladder flap as a patch is feasible and provides good continence, especially for those with serious bladder neck avulsion and urethral rupture caused by extensive trauma and those who had posttraumatic urethral distraction needed second repair.

Pelvic fracture urethral injuries associated with rectal injury: a review of acute and definitive urologic and bowel management with long term outcomes.

Pelvic fracture urethral injuries (PFUI) with simultaneous rectal lacerations are unique rarely reported injuries. This paper serves to define our management, outcomes and make recommendations to improve the care of these patients. We retrospectively reviewed all patients with a PFUI and concurrent rectal injury treated from 1990-2018, initial surgical treatments, along with definitive surgical repair were reviewed. Statistical analysis considered P values <0.05 as significant. Eighteen patients were identified; median follow-up post injury is 4 years, range 1-12 years. Injuries that impacted urologic care included concurrent bladder neck lacerations (BNL) in 50% (9/18) and concurrent neurologic injuries in 28% (5/18). In the nine patients with a simultaneous BNL, 44% (4/9) underwent a primary sutured anastomotic repair of the BNL and urethra, 33% (3/9) underwent primary closure of the bladder neck and SPT drainage and 23% (2/9) had primary repair of BNL with urethral realignment. Continued urinary extravasation through the BN despite the initial surgery resulted in life threating pelvic sepsis in 56% (5/9) versus 0% (0/9) in the patients without a bladder neck laceration, P=0.012. Long term follow up revealed, 22% (2/9) are currently voiding per urethra, neither are continent, one with chronic diaper dependent incontinence, one with stress incontinence. Urinary continence was eventually obtained in 44% (4/9) with either closure of the bladder neck and creation of a continent catheterizable stoma (3 pts) or with cystectomy and creation of an Indiana pouch (1 pt), 33% (3/9) were managed with eventual cystectomy and an enteric urinary conduit. In the nine patients with no concurrent bladder neck injury all were managed with a suprapubic tube placement and consideration for a delayed urethral reconstruction. Delayed end to end urethroplasties were performed in 67% (6/9). Eighty-three percent (5/6) are continent, 50% (3/6) are voiding per urethra without sequale, 33% (2/6) developed recurrent urethral strictures, one was treated with a single DVIU and has retrained urethral patency, at four years post treatment, one is on daily intermittent catheterization to maintain patency. Stress incontinence is noted in 17% (1/6). Due to concurrent neurologic injuries 33% (3/9) of these pts did not undergo further attempt at repair and have been managed with a long-term suprapubic tube. PFUI with simultaneous rectal lacerations have significant comorbid injuries, especially, concurrent bladder neck lacerations and neurologic injuries that affect the urologic prognosis. In patients with a concurrent BNL we recommend initial intervention include primary lower urinary tract reconstruction with simultaneous proximal urinary diversion to help prevent the complication of persistent urinary extravasation with resultant pelvic sepsis.

Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy: Urinary continence recovery.

PurposeTo evaluate early recovery of urinary continence after robot-assisted radical prostatectomy (RARP) with urethral realignment using bladder neck preservation (BNP) and maximal urethral length preservation (MULP).MethodsPatients who underwent RARP between 2014 and 2017 owing to prostate cancer with a Gleason score ≤ 7 (3+4), ≤ cT2c stage, and prostate-specific antigen level < 20 ng/ml were investigated. Patients with tumors of the bladder neck or apex on magnetic resonance imaging were excluded. A total of 266 patients underwent the operation using the standard method between 2014 and 2015 (group 1), while 305 patients underwent urethral realignment between 2016 and 2017 (group 2). Continence was defined as wearing no pad or one security pad.ResultsThe continence rates immediately after Foley catheter removal, at 2 weeks, and at 1, 3, 6, and 12 months after operation in group 2 were 46.9%, 63.0%, 73.4%, 90.1%, 94.8%, and 98.7%, respectively. The continence rate at 1 month in group 2 was significantly higher than that in group 1 (65.4% versus 73.4%, p = 0.037). The multivariate regression analysis showed that age and surgical method were factors affecting early continence recovery. The positive surgical margin rates were 18.0% and 14.8% in groups 1 and 2, respectively (p = 0.288). Biochemical recurrence occurred in 14.7% and 8.2% in groups 1 and 2, respectively (p = 0.015).ConclusionUrethral realignment using BNP and MULP resulted in rapid continence recovery and good oncological results after RARP in young patients with a Gleason score ≤ 7 and organ-confined disease.

Ureterscopic urethral realignment for the treatment of male posterior urethral rupture

目的 探讨输尿管镜下尿道会师术治疗男性后尿道断裂的疗效及安全性。 方法 回顾性分析本院自2011年3月至2015年5月收治的13例后尿道断裂的男性患者，行输尿管镜下尿道会师术的临床资料。 结果 有9例患者单纯经尿道输尿管镜下尿道会师术成功，4例患者联合耻骨上膀胱造瘘通道下行尿道会师术成功。手术时间15～55 min。术后随访1～4年，有9例患者排尿困难，其中6例患者定期尿道扩张后治愈，另3例患者接受尿道内切开术，其中2例患者经尿道内切开并按时扩张后治愈，1例患者最终在上级医院完成尿道狭窄段切除及尿道端端吻合术后治愈。有8例患者发生不同程度的性功能障碍。无患者发生尿失禁。 结论 输尿管镜下尿道会师术治疗男性后尿道断裂能够早期恢复尿道连续性，且损伤小、出血少、恢复快，值得临床推广。

Surgical selection and outcome for treating the post-traumatic posterior urethral strictures via transperineal approach

Objective To evaluate the outcome of various operative selection for treating posterior urethral stricture via transperineal approach. Methods The clinical data of 5 000 patients with posterior urethral stricture or obstruction from January 1990 to January 2017 were analyzed retrospectively. All patients were male. The age of those patients ranged from 18 months to 77 years old, mean 36.6 years old. Pelvic crush injury caused by car accident occurred in 2010 cases. Falling injury occurred in 1680 cases. Pelvic compressed injury occurred in 1 310 cases. Accompanied visceral damage occurred in 2 590 cases, including the liver and spleen rupture in 920 cases, lower limb fracture in 1 200 cases. 2 200 cases accepted urethral realignment under emergency. 2 800 cases were treated with pubic cystostomy. All patients were undergone a retrograde and voiding urethrogram. 562 patients accepted urethral ultrasongraphy, and 2 448 patients accepted urethroscopy. 204 patients accepted MRI examination. The mean stricture length was 4.3 cm, ranged from 1.8 to 8.6 cm. Posterior urethral stricture was found in 810(16.2%)cases. The complete obstruction of posterior urethra was found in 4 190(83.8%)cases, of which the length of the distraction defects≤3 cm was found in 2 650(53.0%)cases and the length of the distraction defects>3 cm was found in 1 540(30.8%)cases. Bladder calculi was found in 2 300 cases. The perineal fistula or abscess was noticed in 290 cases. False passage was found in 460 cases. Urethra rectum fistula was found in 160 cases. Bladder neck open was noticed in 89 cases. Repairing was performed via a simple anastomosis after urethral mobilization in 1 700 patients, via separation of the corporeal bodies in 1 302 patients, via separation of the corporeal bodies and inferior pubectomy in 1 910 patients and via scrotal skin flap urethroplasty in 68 patients. Pull-through operation was performed in 20 patients. Results Postoperative follow-up were conducted from 6 to 72 months with average duration of 23 months. The overall successive results after operation was 92.2%(4 608/5 000), which the Qmax was more than 15 ml/s .The successive rate of urethroplasty were 97%(1 649/1 700 )in simple anastomosis; 93%(1 211/1 302 )in separation of the corporeal bodies; 88% (1 680/1 910) in separation of the corporeal bodies and inferior puberctomy; 78%(53/68) in scrotal skin flap urethroplasty and 83%(15/18) in pull-through operation. The successive rate were 96%(778/810)in posterior urethral stricture; 95%(2 517/2 650)in distraction with the length of obstruction less than 3 cm and 86%(1 324/1 540)in distraction with the length of obstruction more than 3 cm. Conclusions The transperineal end to end anastomotic urethroplasty has become the first-line therapy for posterior urethral atresia. The length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected. Key words: Urethral stricture; Urological surgical procedure; Transperineal; Wound and injuiry

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.

An American Association for the Surgery of Trauma (AAST) prospective multi-center research protocol: outcomes of urethral realignment versus suprapubic cystostomy after pelvic fracture urethral injury.

BackgroundPelvic fracture urethral injuries (PFUI) occur in up to 10% of pelvic fractures. It remains controversial whether initial primary urethral realignment (PR) after PFUI decreases the incidence of urethral obstruction and the need for subsequent urethral procedures. We present methodology for a prospective cohort study analyzing the outcomes of PR versus suprapubic cystostomy tube (SPT) after PFUI.MethodsA prospective cohort trial was designed to compare outcomes between PR (group 1) and SPT placement (group 2). Centers are assigned to a group upon entry into the study. All patients will undergo retrograde attempted catheter placement; if this fails a cystoscopy exam is done to confirm a complete urethral disruption and attempt at gentle retrograde catheter placement. If catheter placement fails, group 1 will undergo urethral realignment and group 2 will undergo SPT. The primary outcome measure will be the rate of urethral obstruction preventing atraumatic passage of a flexible cystoscope. Secondary outcome measures include: subsequent urethral interventions, post-injury complications, urethroplasty complexity, erectile dysfunction (ED) and urinary incontinence rates.ResultsPrior studies demonstrate PR is associated with a 15% to 50% reduction in urethral obstruction. Ninety-six men (48 per treatment group) are required to detect a 15% treatment effect (80% power, 0.05 significance level, 20% loss to follow up/death rate). Busy trauma centers treat complete PFUI approximately 1–6 times per year, thus our goal is to recruit 25 trauma centers and enroll patients for 3 years with a goal of 100 or more total patients with complete urethral disruption.ConclusionsThe proposed prospective multi-institutional cohort study should determine the utility of acute urethral realignment after PFUI.

Abstract No. 569 Interventional urethral realignment as a radical treatment in posterior urethral disruption accompanied by complex pelvic fracture

Unlike anterior urethral injury, posterior urethral rupture accompanied by complex pelvic fracture would have the distance between the ruptured urethra becoming wider due to pelvic hematoma, and thus, interventional urethral realignment would be expected to face similar difficulties as surgical urethral realignment. The purpose of this study was to evaluate the clinical efficacy of interventional urethral realignment as a radical treatment in patients with posterior urethral disruption. This retrospective study included 8 patients with traumatic posterior urethral disruptions who were treated with interventional urethral realignment between November 2016 and September 2017. All 8 patients were men with the mean age of 50.5 years. Reviewed results included patient demographics, technical success rate of interventional urethral realignment, fluoroscopic findings, manner of procedure, required procedure time, duration of urethral catheterization, and procedure-related complications. Interventional urethral realignment was technically successful in 6 of 8 patients (75.0%). The majority of patients were young male involved in motor vehicle crashes. In 5 patients, the catheter previously placed by retrograde urethrography was used as a landmark, and the antegrade guidewire was successfully navigated through the free space of urethra separated further by rupturing and exited through the outer urethral orifice by finding the true lumen of the distal urethra. In one patient, the rendezvous technique with a snare catheter in the free space was used. The mean procedure time was 51.2 minutes (range, 40–65 min). The mean duration of urethral catheterization after interventional urethral realignment was 63 days (range, 48–94 d). There were no immediate complications related to procedure, although all patients developed symptomatic urethral stenosis after urethral realignment. Interventional urethral realignment is a safe and minimally invasive procedure that can be performed in a patient with posterior urethral rupture accompanied by complex pelvic fracture. Thus, it can be viewed as a radical treatment that can reduce the frequency of invasive surgical procedures.

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.

When to remove the urethral catheter after endoscopic realignment of traumatic disruption of the posterior urethra?

To detect the optimal time for urethral stent removal after endoscopic urethral realignment and its effect on the incidence of development of urethral stricture. Eighteen patients underwent endoscopic urethral realignment after traumatic disruption of the posterior urethra. Post-operative urethroscopy was done using the flexible cystoscope to assess progress of urethral healing. The urethral Foley catheter that served as a stent and for urine drainage was removed only when complete mucosal healing was observed by flexible urethroscopy. There was a post-operative follow-up period of 12-36months. Uroflowmetry was performed at the end of the follow-up period. Endoscopy 6weeks after realignment showed 50-75% mucosal epithelialization at the site of urethral disruption in all patients. Epithelialization was complete at 9weeks in 15/18 patients (83%) and at 12weeks in the remaining 3 patients (17%). One patient (5.6%) developed a mild symptomatic stricture 5months post stent removal that was successfully treated by a single session of visual urethrotomy. All 18 patients had normal uroflowmetry readings at 12-36months after realignment. Urethral stenting should be continued till mucosal healing at the site of urethral disruption became complete. Removal of the stent at this optimal time decreases the incidence of post-operative urethral stricture. Flexible urethroscopy was a safe procedure for post-operative follow-up of endoscopic urethral realignment to assess the progress and completion of mucosal healing at the site of realignment. 4.

Uso de tadalafilo en la rehabilitación de pacientes con antecedente de lesión de uretra posterior en el contexto de fractura pélvica

ObjectiveTo evaluate the tadalafil effect in the treatment of erectile dysfunction as a consequence of posterior urethral injury. Material and methodsThis is a retrospective study that included patients with posterior urethral injury caused by previous pelvic fracture; our patients received emergency urethral alignment and urethroplasty between 8 to 10weeks after trauma. To assess the degree of erectile dysfunction pre- and post-treatment, we applied the questionnaire of International Index of Erectile Function (IIEF-5). Statistics Wilcoxon test and descriptive statistics were performed. ResultsEight patients were included in this study, with an average age of 32.5years; the IIEF scale prior to treatment was on average 8.5 points and increased to 12.36 points with a value of P=.011. DiscussionThese eight patients showed erectile dysfunction at the time of IIEF assessment, this due to emergency urethral realignment arising from the trauma caused by pelvic fracture. Treatment with inhibitors of 5-phosphodiesterase (iPDE5) is the first-line treatment in patients with erectile dysfunction because it is efficient, non-invasive and well tolerated. In this study we found results indicating good response to this treatment in 7 out of the 8 patients (87.5%). Only one patient showed no improvement after treatment, due to the presence of risk factors such as age (65years), tobacco use, and high blood pressure. ConclusionThe 87.5% of patients with urethral injury medicated with tadalafil were rehabilitated.

PD29-08 WHEN TO REMOVE THE FOLEY CATHETER AFTER ENDOSCOPIC REALIGNMENT OF TRAUMATIC DISRUPTION OF THE POSTERIOR URETHRA?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2017PD29-08 WHEN TO REMOVE THE FOLEY CATHETER AFTER ENDOSCOPIC REALIGNMENT OF TRAUMATIC DISRUPTION OF THE POSTERIOR URETHRA? Hamed El Darawani Hamed El DarawaniHamed El Darawani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1360AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To verify a correlation between the period of urethral stenting after endoscopic urethral realignment and the incidence of post-operative urethral stricture. This study was designed to evaluate the outcome of continuing urethral stenting till the gap between the 2 realigned urethral segments has been completely epithelialized. METHODS Eighteen patients underwent endoscopic urethral realignment after traumatic disruption of the posterior urethra. Post-operative urethroscopy was done using the flexible cystoscope to assess the progress of urethral healing. The urethral Foley catheter that acted as a stent and also for urine drainage was removed when complete mucosal healing was observed by urethroscopy. Post-operative development of urethral stricture was noted and uroflowmetry was done at 12–36 months. RESULTS Endoscopy 6 weeks after realignment showed 50%-75% epithelialization in all patients (figure 1). At 9 weeks, epithelialization was 100% in 15/18 patients (83%) and complete epithelialization at 12 weeks in all patients (figure 2). After stent removal, 1 patient (5.6%) developed a mild symptomatic stricture that was successfully treated by a single session of visual urethrotomy. All 18 patients had normal uroflowmetry readings at 12-36 months after realignment. CONCLUSIONS Following endoscopic urethral realignment, urethral stenting till mucosal healing was complete reduced the incidence of subsequent urethral stricture. Urethroscopy showed complete mucosal healing in 9–12 weeks after realignment. During a follow-up period of 12-36 month, 94.4% of the patients were symptom-free. Presence of asymptomatic large-caliber strictures or possibility of development of symptomatic strictures during longer follow-up periods can’t be ruled out. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e575 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Hamed El Darawani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...