Outcome of patients with failed pelvic fracture-associated urethral injury repair: A single centre 10-year experience

Garg, Gaurav; Singh, Manmeet; Kumar, Manoj; Aggarwal, Ajay; Pandey, Siddharth; Sharma, Deepanshu; Sankhwar, Satya Narayan

doi:10.5152/tud.2018.36824

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…These injuries may sometimes require multiple procedures. Sometimes, in unreconstructible injuries, an appendicovesicostomy (Mitrofanoff) may be used to provide the patient with a continent catheterisable cutaneous channel to empty the bladder while allowing them to be free of an indwelling tube 1. In some studies, a radial free forearm flap has also been used to create the posterior urethra 1.…”

Section: Discussionmentioning

confidence: 99%

“…Pelvic fracture urethral injury (PFUI) is a complex traumatic injury of the pelvis in which the urethra is damaged. This type of injury is associated with 10% of all pelvic fractures and is particularly more common when there is diastasis of the pubic bones or an inferomedial fracture of the pubic bones with displacement 1. Despite the best efforts, the success rate for posterior urethral strictures is around 88.9%, with initial incontinence rates of up to 30% in complex cases 2.…”

Section: Introductionmentioning

confidence: 99%

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Utilising anterolateral bladder flap to create a continent cutaneous diversion in a patient with pelvic fracture urethral injury

Anand,

Kumar,

Yadav

et al. 2023

BMJ Case Rep

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A male child in the first decade of life presented to us with a history of a pelvic fracture and urethral injury resulting from a road traffic accident 4 months prior. He had previously undergone an exploratory laparotomy and suprapubic cystostomy at another medical centre. He was circumcised and exhibited a substantial urethral defect on the retrograde urethrogram, as well as on the micturating cystourethrogram. Following a careful assessment of the patient’s and caregivers’ expectations, a continent cutaneous catheterisable channel was planned. This procedure involved the use of an anterolateral bladder flap, and continence was achieved through the creation of a Nissen-type seromuscular invagination. Three months postoperatively, the child remains continent, can easily catheterise the stoma and has resumed his education.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utilising anterolateral bladder flap to create a continent cutaneous diversion in a patient with pelvic fracture urethral injury

Anand,

Kumar,

Yadav

et al. 2023

BMJ Case Rep

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“…Recurrent stenosis after urethroplasty is significantly associated with more severe scarring and devitalized tissues secondary to the previous dissection. In 50 patients with previous failed repair, the success rate was 75% [ 19 ]. In a recent systematic review of literature, the success rate of PU for recurrent strictures varied from 69–100% [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury?

Harraz

Nabeeh

Elbaz

et al. 2022

Arab Journal of Urology

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Objectives To identify cystourethrogram (CUG) findings that independently predict the outcome of posterior urethroplasty (PU) following pelvic fracture urethral injury (PFUI). Methods Findings of CUG included the location of the proximal end of the bulbar urethra in zones A (superficial) or B (deep) according to its relationship with the pubic arch. Others included the presence of pelvic arch fracture, bladder neck, and posterior urethral appearance. The primary outcome was the need for reintervention either endoscopically or by redo urethroplasty. Independent predictors were modeled using a logistic regression model and a nomogram was constructed and internally validated using 100-bootstrap resampling. Time-to-event analysis was performed to validate the results. Results A total of 196 procedures in 158 patients were analyzed. The success rate was 83.7% with 32 (16.3%) procedures requiring direct vision internal urethrotomy, urethroplasty, or both in 13 (6.6%), 12 (6.1%), and 7 (3.6%) patients, respectively. On multivariate analysis, bulbar urethral end located at zone B (odds ratio [OR]: 3.1; 95% confidence interval [CI]: 1.1–8.5; p = 0.02), pubic arch fracture (OR: 3.9; 95%CI: 1.5–9.7; p = 0.003), and previous urethroplasty (OR: 4.2; 95% CI: 1.8–10.1; p = 0.001) were independent predictors. The same predictors were significant in the time-to-event analysis. The nomogram discrimination was 77.3% and 75% in the current data and after validation. Conclusions The location of the proximal end of the bulbar urethra and redo urethroplasty could predict the need for reintervention after PU for PFUI. The nomogram could be used preoperatively for patient counseling and procedure planning.

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“…To overcome this limitation, various specially designed instruments, suture needles, and retractors have been introduced for use during this procedure (15). The struggle to complete this anastomosis in the difficult conditions of poor access increases the risk of poor tissue handling and of performing anastomosis of doubtful integrity, resulting in poor outcome with its attendant burden on the patient, the surgeon, and the health system (6,16). Recurrence of posterior urethral fibrosis requiring further procedures or repeat reconstructions is common (17).…”

Section: Discussionmentioning

confidence: 99%

Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

Nnabugwu¹,

Ugwumba²,

Ilukwe³

2021

Ann Afr Surg.

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Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the medium- to longterm outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s (mean: 21 mL/s). The longest duration of follow-up was 34 months, and all patients were voiding satisfactorily. Conclusions: A satisfactory and durable outcome can be obtained from nibbling at the bone from the inferior margin of the pubic bone to achieve PIP. This is of interest to lower urinary tract reconstructive surgeons who have concerns with chiseling-out wedge of the inferior pubis. Keywords: Bone nibbling, Partial inferior pubectomy, PFUI, Posterior urethra, Urethral anastomosis

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Outcome of patients with failed pelvic fracture-associated urethral injury repair: A single centre 10-year experience

Abstract: I n d e x e d i n P u b M e d , W e b o f S c i e n c e a n d S c o p u s İsa Burak Güney, et al., The role and effect of FDG-PET/CT on patient management and restaging of bladder carcinoma.

Cited by 4 publications

References 23 publications

Utilising anterolateral bladder flap to create a continent cutaneous diversion in a patient with pelvic fracture urethral injury

Utilising anterolateral bladder flap to create a continent cutaneous diversion in a patient with pelvic fracture urethral injury

Could the bulbar urethral end location on the cystourethrogram predict the outcome after posterior urethroplasty for pelvic fracture urethral injury?

Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

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