A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury

Abstract

Purpose: Male urethral injury is a common urologic emergency in developing countries. Whether early or late treatment of urethral injuries is often multifactorial and controversial. The goal of this study is to determine whether early realignment can reduce postsurgical complications and evaluate the clinical feasibility of emergency endoscopic urethroplasty using single rigid ureteroscopy in the treatment of bulbar urethral severe injury. Patients and Methods: Between September 2013 and March 2019, 15 male adult patients (mean age 35 years; from 21 to 62 years) with severe bulbar urethral injury were enrolled into the current study. The patients mainly presented with dysuria or painful urination (15/15, 100%), urethral bleeding (13/15, 86.7%), and urinary retention (11/15, 73.3%). Six of them had swelling of perineal or scrotal soft tissue, while four had testicular contusion. No pelvic fracture was found in all cases with CT scanning of the pelvic cavity. The bulbar urethral at grade IV was confirmed to be completely ruptured in all cases by endoscopy during operation. The modified endoscopic primary realignment was performed. Results: This new urethral repair technique was effectively performed in all patients and none converted to open operation. Mean operation time was 42.3-11.5 minutes (28-52 minutes) and the mean Foley catheter indwelling time was 34.5-6.9 days (28-42 days). During a follow-up of 41.3-22.8 months (12-64 months), mild urethral strictures (grade I) (19.7-9.5 weeks, 10-27 weeks postsurgery) developed in 8 patients (53.3%) and then were all improved 2.1-0.8 months (1.3-2.9 months) after periodic dilatations of the urethra (4-10 times). Erectile dysfunction (ED) occurred in three patients (20%) after surgery, who recovered from mild ED to normal by administration with oral sildenafil (100 mg, three times a week) for 12 weeks. The International Index of Erectile Function-5 (IIEF-5) score was significantly improved after surgery (M-SD, 25-3) compared with before (16.4-3.5) (p < 0.05). No incontinence and other complications occurred in all cases. Conclusions: Early endoscopic realignment via suprapubic puncture cystostomy by single rigid ureteroscopy provides an effective, feasible, and safe procedure for severe bulbar urethral injury.

Novel method of primary endoscopic realignment for high-grade posterior urethral injuries: A case report

“…They concluded that while PER may result in the restoration of urethral continuity without the need for further intervention, PER patients may require multiple interventions and experience more adverse events than SPT patients. Zhang et al [ 6 ] reported a modified procedure involving the use of standard semi-rigid ureteroscopy to reduce manipulation-related trauma, which resulted in a good success rate and a low subsequent comorbidity rate. However, the suprapubic route was established by means of serial sheath dilatations and then completed using a 16-Fr peel-away sheath.…”

“…In an effort to increase the success rate of PER, one retrospective study suggested performing antegrade realignment via the suprapubic tract using semi-rigid ureteroscopy[ 6 ]. However, this technique requires the use of a unique peel-away sheath to establish a suprapubic tract, which is not currently widely accessible.…”

Fibrinogen/poly(l-lactide-co-caprolactone) copolymer scaffold: A potent adhesive material for urethral tissue regeneration in urethral injury treatment

“…Since urethral wounds are infrequent, their occurrence has already been growing due to an increase in the number of highway vehicle accidents [ 50 ]. The preponderance of urethral injuries can be caused by either blunt trauma to the abdominal (typically coupled with a pelvic fracture) or straddling damage to the pelvis [ 38 ].…”

Sexual dysfunction associated with chronic retention of foreign bodies in the low urinary tract

“…Most patients seek medical attention immediately or within a few days after by visiting a physician. Additionally, while chronic retention of foreign bodies in the bladder and urethra does occur, these cases that tend to lead to renal failure have been rarely reported, and only a few involved sexual function (Bedke et al, 2010;Singh, 2007;Zhang et al, 2021). There are limited data about sexual function and its relationship with chronic foreign body retention in the LUT.…”