Frequency of Extravasation on Pericatheter Retrograde Urethrogram in Patients Who Undergo Posterior Urethroplasty

Abstract

Introduction Urethroplasty is the gold standard treatment for urethral stricture disease resulting from pelvic fractures, urethral manipulation, and straddle injuries. Post-operative morbidity depends on the presence of urethral catheterization with or without a suprapubic catheter (SPC). Urethral healing at the anastomotic site can be easily assessed using retrograde pericatheter urethrography (RPU). Post-operative removal of the catheter is traditionally performed on the 21 st day following urethroplasty. However, some controversy still exists regarding the best feasible time of proper urethral healing and its assessment utilizing simple techniques. The duration of anastomotic healing differs depending on the type of procedure performed, but whether there is any significant difference in duration of healing at the anastomotic site according to the etiology of short‐segment stricture urethra is still a dilemma. Materials and methods This was a descriptive case-series conducted for a duration of six months from September 2019 to February 2020 at the urology department of a tertiary care hospital in Karachi, Pakistan. A sample population of 135 patients aged 20-50 years with posterior urethral stricture who underwent posterior urethroplasty with disease duration of >12 months was included in the study. All patients were put on the next operation theater (OT) list for urethroplasty. After surgery, the patients were catheterized and were kept in the ward under observation for 48 hours and discharged on the 2 nd post-operative day. All patients were followed weekly and RPU was performed on the 21 st day following urethroplasty to assess the presence of extravasation and the collected data was entered into the proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0. Results The mean age of our participants was 32.8±6.02 years. The mean duration of the procedure was 26.3±7.14 months. Extravasation cases were observed in less than one-fifth (n=22 out of 135, 16.3%) of the posterior urethral stricture patients in our study. Conclusions It is to be concluded that extravasation is fairly common in patients who undergo posterior urethroplasty. The prevalence varies depending on the assessment method, likely reflecting the treatment of somatic symptoms.

Fluoroscopic Evaluation of the Male Urethra in the Setting of Trauma

“…A pericatheter RUG is performed in a similar manner by injecting contrast adjacent to a preexisting urethral catheter and evaluating for sites of contrast extravasation. 15 In cases of trauma, a detailed description of urethral injury should include location of injury, and injury features: normal urethral appearance, luminal narrowing without contrast extravasation, contrast extravasation with or without urethral continuity allowing for continuation of the contrast column beyond the site of injury, abrupt termination of the contrast column with or without contrast extravasation. These features relay the understanding as to whether the urethral injury may reflect a contusion (no contrast extravasation), partial disruption (extravasation with continuation of the contrast column beyond the site of injury), or complete disruption (abrupt termination of the contrast column or extravasation without continuation of the contrast column beyond the site of injury).…”

“…These cases still warrant evaluation with RUG, which can be performed in a pericatheter fashion. A pericatheter RUG is performed in a similar manner by injecting contrast adjacent to a preexisting urethral catheter and evaluating for sites of contrast extravasation 15…”