Effectiveness of Transpu B Ic Urethroplasty for Recurrent Urethral STR U Cture in Pelvic Fracture Urethral Distraction Defect

Abstract

AIM OF THE STUDY: Effectiveness of Transpubic urethroplasty in recurrent (failed) urethral strictures due to pelvic fracture urethral distraction defects. INTRODUCTION: Urethral distraction injuries occur upto 10% of pelvic fracture cases. The principle indication of Transpubic urethroplasty is length >3cms, recurrent (failed) repairs of posterior urethral stricture. Though other procedures like primary anastomotic urethroplasty, rerouting of the urethra under the corporal body, urethral substitution with tubularised flaps, two stage urethroplasty are described, Transpubic urethroplasty is said to produce the best results especially when repeat procedures are required. MATERIALS & METHODS: This is a prospective study from 2004 to 2014 consisting of 17 patients having recurrent stricture urethra secondary to pelvic fracture urethral distraction defects (PFUDD). All the patients were males and their age ranged from 15year to 45 years. Pre-op evaluation included X-ray KUB, Ultrasound abdomen & pelvis, retrograde urethrogram (RGU), micturating cystourethrogram (MCU), up and down Cystoscopy, urine culture and renal biochemical parameters. Urethra was approched through progressive perineal and abdominal approach with total pubectomy, followed by excising fibrosed stricture and tension free end to end anastomosis. Post operatively pericatheteral RGU was carried out after 4 weeks and Catheter removed if there was no leak. RGU, MCU uroflowmetry and PVR were done one month after removal of catheter. Subsequently UFR, PVR and obstructive symptoms were assessed periodically. RESULTS: All 17 Cases were followed up for a period of 3-11 years. Out of 17patients, 14(80%) patients maintained good uroflow (UFR) and insignificant PVR and procedure was considered successful. In 3 patients procedure failed, of which 2 patients had pericatheter leak and reduced urinary flow with significant PVR and were followed up with CIC and 1 patient remained on permanent SPC. Overall stricture free rate was 80%. CONCLUSION: Transpubic urethroplasty appears to be superior substitute for recurrent stricture due to pelvic fracture urethral distraction defects (PFUDDs). Pericatheteral leak, fibrosis, fistulae seems to be an important factor in determining the successful outcome.