Factors Contributing to a Successful Outcome of Combined Abdominal Transpubic Perineal Urethroplasty for Complex Posterior Urethral Disruptions

Pratap, Akshay; Agrawal, Chandra Shekhar; Pandit, Rakesh; Sapkota, Ganga; Anchal, Nitish

doi:10.1016/j.juro.2006.08.016

Cited by 17 publications

(7 citation statements)

References 16 publications

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“…2 When necessary, usually when adequate access to the proximal urethral end cannot be obtained by these four steps (particularly in children, re-do cases, and cases with complex stenosis accompanying recto-urethral fistula, periurethral cavity, false passage and/or open bladder neck), an abdominoperineal approach could be required (Figs 8,9). 23,[64][65][66][67][68] It has been highlighted that the final decision on the type of repair (i.e. which ancillary technique is required) usually depends not on the preoperative imaging, but on the findings at surgery.…”

Section: Assessment Of Urethral Stenosismentioning

confidence: 99%

“…The use of the first two steps alone is categorized as the simple perineal approach, and the inclusion of steps 3 and 4 is categorized as the elaborated perineal approach . When necessary, usually when adequate access to the proximal urethral end cannot be obtained by these four steps (particularly in children, re‐do cases, and cases with complex stenosis accompanying recto‐urethral fistula, periurethral cavity, false passage and/or open bladder neck), an abdominoperineal approach could be required (Figs ,) . It has been highlighted that the final decision on the type of repair (i.e.…”

Section: Delayed Management For Pfuimentioning

confidence: 99%

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Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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Section: Assessment Of Urethral Stenosismentioning

confidence: 99%

Section: Delayed Management For Pfuimentioning

confidence: 99%

Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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“…Historically, realignment was done as an open procedure. The invasiveness of this approach was found to cause a greater risk of urinary incontinence for the patient [12,13] . In the modern era, open realignment is rarely indicated, except if there are concomitant bladder, bladder neck, or rectal injuries.…”

Section: Effects Of the Initial Managementmentioning

confidence: 99%

The mechanism of continence after posterior urethroplasty

Bagga

Angermeier

2015

Arab Journal of Urology

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The standard of care after a pelvic fracture urethral injury is a repair via a one-stage anastomotic posterior urethroplasty using a step-wise perineal approach. The initial injury, immediate postoperative management, and surgical repair can all affect urinary continence in these patients. Proximal continence mechanisms, particularly the bladder neck, are particularly important in maintaining urinary continence in these patients. Patients with bladder neck dysfunction should be counselled about the greater risk of urinary incontinence.

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“…Even in patients with unfavorable conditions, such as a stricture gap that exceeds 3 cm, a previously failed repair, associated perineal fistulas, rectourethral fistulas, periurethral cavities, false passages, or an open bladder, the aforementioned factors are key to a successful urethral reconstruction [3]. However, these complex conditions may require removal of a vast amount of tissue, which creates a large dead space.…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors That Predict Successful Posterior Urethral Anastomosis With a Gracilis Muscle Flap

et al. 2013

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PurposeWe evaluated the preoperative clinical factors that affect the surgical outcome of posterior urethral anastomosis (PUA) with a gracilis muscle flap (GMF) to determine which factors predict benefit from the use of the GMF.Materials and MethodsThis was a retrospective analysis of 49 patients who underwent a delayed PUA with a GMF. A successful clinical outcome was defined as achieving a peak urinary flow rate greater than 15 mL/s at 3 and 12 months postoperatively without evidence of stricture recurrence on a retrograde urethrogram or cystourethroscopy at 3 months postoperatively. Multiple clinical factors were evaluated by use of univariate and multivariate analyses.ResultsThe outcome of 21 of 49 patients (42.9%) was deemed successful. The mean age of the 49 patients was 37.2±13.5 years and the mean follow-up duration was 43.4±28.0 months. The length of the urethral defect was significantly shorter in patients with a successful outcome than in patients with an unsuccessful outcome (p=0.010). The outcome differed significantly depending on whether the patients had a previously successful urethroplasty (p=0.036) or whether they had suffered a pelvic bone injury (p=0.012). Multivariate logistic regression analyses revealed that a previous urethroplasty was the only preoperative clinical factor that significantly affected the surgical outcome in PUA with a GMF (odds ratio, 0.218; 95% confidence interval, 0.050 to 0.947; p=0.042).ConclusionsA history of previous urethroplasty is a preoperative clinical factor that significantly affects the surgical outcome in PUA with a GMF; the procedure is more likely to be successful in patients who have not previously undergone urethroplasty.

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Factors Contributing to a Successful Outcome of Combined Abdominal Transpubic Perineal Urethroplasty for Complex Posterior Urethral Disruptions

Abstract: Hostile conditions in the perineum of patients with complex posterior urethral disruption mitigate against a good result. However, the safety and success of combined abdominal transpubic perineal urethroplasty make it the procedure of choice for these difficult strictures.

Cited by 17 publications

References 16 publications

Management of male pelvic fracture urethral injuries: Review and current topics

Management of male pelvic fracture urethral injuries: Review and current topics

The mechanism of continence after posterior urethroplasty

Clinical Factors That Predict Successful Posterior Urethral Anastomosis With a Gracilis Muscle Flap

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