Immediate Management of Posterior Urethral Disruptions Due to Pelvic Fracture: Therapeutic Alternatives

Podestá, Miguel Luis; Medel, Ricardo; Castéra, Roberto; Ruarte, Adolfo C.

doi:10.1016/s0022-5347(01)65016-x

Cited by 40 publications

(44 citation statements)

References 21 publications

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“…Boone et al [14] noted that three distinct types of urethral injury (supraprostatic, transprostatic and prostatomembranous) are present in this population. Moreover, because of a small prostate, violent pelvic injuries in childhood may be responsible for complete rupture of the membranous urethra as well as urethral disruption at the bladder neck [24,25]. In addition, Glassberg et al described in children extension of the urethral disruption injury at the prostatomembranous junction into the proximal bulbar urethra [26].…”

Section: Perineal Anastomotic Urethroplasty and Transpubic Repairmentioning

confidence: 99%

Post-traumatic urethral strictures in children: What have we learned over the years?

Ranjan

Ansari

Singh

et al. 2012

Journal of Pediatric Urology

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Section: Perineal Anastomotic Urethroplasty and Transpubic Repairmentioning

confidence: 99%

Post-traumatic urethral strictures in children: What have we learned over the years?

Ranjan

Ansari

Singh

et al. 2012

Journal of Pediatric Urology

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“…Although these complications seem to be related to the severity of the primary injury of the pelvic trauma and associated bladder neck rupture [24], prompt surgical repair cannot be recommended due to the often critical general state and associated injuries of the child. Immediate open repair may remove the tamponade effect caused by the pelvic hematoma and thus carries the potential for hemorrhage.…”

Section: Therapymentioning

confidence: 99%

Diagnosis and Management of Pediatric Urethral Injuries

Pichler¹,

Fritsch

Skradski³

et al. 2012

Urol Int

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Objective: The incidence of urethral injuries in children is rare due to the fact that the urethra is short, mobile and protected by the pubic bone. The management of urethral trauma in childhood remains controversial because of the limited expertise of most urologists. Material and Methods: We performed a literature review by searching the Medline database for articles published between 1975 and 2010 based on clinical relevance. Electronic searches were limited to the keywords ‘pediatric’, ‘urethral injury’, ‘trauma’ and ‘reconstruction’. Results: Retrograde urethrography is considered the gold standard for diagnosis of urethral injuries. The initial management should ensure drainage of the bladder either by suprapubic cystostomy or urethral realignment if possible: in complete anterior urethral disruption as well as in children with life-threatening pelvic and intra-abdominal injuries after posterior urethral injuries, a deferred repair after 3 months is necessary. Immediate primary suturing of disrupted and dislocated urethral ends should be avoided because of high complication rates. Primary repair, however, of the defect is possible in girls avoiding a 2-stage approach. Conclusion: The aim of therapy is minimizing remote damages such as urethrocutaneous fistulae, periurethral diverticulae, strictures, incontinence and impotence with different therapeutic management depending on classification of the injury and the presence of life-threatening injuries.

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“…[42] However, some series in the past have reported a larger percentage of use of the transpubic technique ranging from 35% to 75%. [194344] Transpubic approach may be needed in children with defects more than 3 cm long. [43]…”

Section: Urethroplasty For Pfudd In Childrenmentioning

confidence: 99%

“…[40–43] In about 10–11% of children, anastomotic urethroplasty fails. In these cases redo-urethroplasty still has a very high success rate of more than 95%.…”

Section: Urethroplasty For Pfudd In Childrenmentioning

confidence: 99%

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Current concepts in the management of pelvic fracture urethral distraction defects

2011

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Objectives:Pelvic fracture urethral distraction defect (PFUDD) may be associated with disabling complications, such as recurrent stricture, urinary incontinence, and erectile dysfunction. In this article we review the current concepts in the evaluation and surgical management of PFUDD, including redo urethroplasty.Materials and Methods:A PubMed™ search was performed using the keywords “pelvic fracture urethral distraction defect, anastomotic urethroplasty, pelvic fracture urethral stricture, pelvic fracture urethral injuries, and redo-urethroplasty.” The search was limited to papers published from 1980 to March 2010 with special focus on those published in the last 15 years. The relevant articles were reviewed with regard to etiology, role of imaging, and the techniques of urethroplasty.Results:Pelvic fracture due to accidents was the most common etiology of PFUDD that usually involved the membranous urethra. Modern cross-sectional imaging, such as sonourethrography and magnetic resonance imaging help assess stricture pathology better, but their precise role in PFUDD management remains undefined. Surgical treatment with perineal anastomotic urethroplasty yields a success rate of more than 90% in most studies. The most important complication of surgical reconstruction is restenosis, occurring in less than 10% cases, most of which can be corrected by a redo anastomotic urethroplasty. The most common complication associated with this condition is erectile dysfunction. Urinary incontinence is a much rarer complication of this surgery in the present day.Conclusions:Anastomotic urethroplasty remains the cornerstone in the management of PFUDD, even in previously failed repairs. Newer innovations are needed to address the problem of erectile dysfunction associated with this condition.

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Immediate Management of Posterior Urethral Disruptions Due to Pelvic Fracture: Therapeutic Alternatives

Cited by 40 publications

References 21 publications

Post-traumatic urethral strictures in children: What have we learned over the years?

Post-traumatic urethral strictures in children: What have we learned over the years?

Diagnosis and Management of Pediatric Urethral Injuries

Current concepts in the management of pelvic fracture urethral distraction defects

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