Pelvic Fracture Urethral Injuries: The Unresolved Controversy

Koraitim, Mamdouh M.

doi:10.1016/s0022-5347(05)68918-5

Cited by 238 publications

(164 citation statements)

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“…These results are similar to previously reported single surgeon data and represent the success of delayed anastomotic urethroplasty following posterior urethral disruption. 1 Mean and median followup were relatively short in this 25-year experience. However, the constraints of long-term patient contact at a tertiary care referral center are understood.…”

Section: Editorial Commentmentioning

confidence: 74%

“…Differences between patients treated until 1995, the last time the series was analyzed, 1 and those treated after 1995 are presented in the table. In the last 10 years fewer patients have required partial or total pubectomy.…”

Section: Fig 3 Distribution Of Posterior Urethroplasty Cases By Agementioning

confidence: 99%

“…1 These injuries pose a significant management challenge, aggravated by the frequently severe extent of associated organ injuries, initial medical instability of many patients, distortions of pelvic and lower urinary tract anatomy, and the potentially extensive fibrotic response to urinary extravasation. Multiple approaches to these patients have been used in past and recent series.…”

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confidence: 99%

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Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

et al. 2007

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Purpose: Management of posterior urethral disruption due to pelvic trauma can be quite challenging and is the subject of ongoing controversy. This study presents an update of the University of California, San Francisco experience with delayed anastomotic posterior urethroplasty for management of these injuries. Materials and Methods:Since 1979 all patients undergoing posterior urethroplasty by a single surgeon at University of California, San Francisco and its affiliated hospitals have been entered prospectively into a patient registry. For this cohort descriptive statistics were calculated and recurrence was analyzed with the Kaplan-Meier method. Success was defined as no recurrence (by symptoms and/or retrograde urethrogram) or a mild recurrence managed successfully with a single internal urethrotomy. Results: A total of 134 male patients were analyzed with a mean of 32.9 and a median of 12 months followup. Mean patient age at surgery was 34.8 years. Of the patients 35% had undergone at least 1 prior procedure for stricture including prior urethroplasty in 16%. In addition, 22% required partial pubectomy and 4% a combined abdominal-perineal approach with total pubectomy. Of patients with a closed bladder neck on urethrography 34% vs 7% of those with an open bladder neck required pubectomy (p Ͻ0.001). Stricture length tended to be longer in pubectomy cases (mean 3.2 vs 2.1 cm by urethrography, p ϭ 0.055). Of the patients 14% experienced recurrent stricture at a mean of 12 months, 42% of whom were treated successfully with a single urethrotomy. The overall success rate allowing 1 direct vision internal urethrotomy was 93%. Conclusions: Anastomotic urethroplasty offers excellent long-term results to patients with posterior urethral trauma and stricture disease even after multiple prior procedures.Key Words: urethra; urethral stricture; anastomosis, surgical; wounds and injuries P osterior urethral injury complicates up to 25% of pelvic fractures arising from blunt pelvic trauma. 1 These injuries pose a significant management challenge, aggravated by the frequently severe extent of associated organ injuries, initial medical instability of many patients, distortions of pelvic and lower urinary tract anatomy, and the potentially extensive fibrotic response to urinary extravasation. Multiple approaches to these patients have been used in past and recent series. Patients treated at or referred to UCSF undergo initial suprapubic cystostomy urinary diversion and some patients referred within the last 10 years have also had an unsuccessful attempt at primary realignment. In this article we present our experience with delayed perineal anastomotic urethroplasty for treatment of these patients in the last 25 years. METHODS All operations were performed by a single surgeon (JWM).The technique for anastomotic posterior urethroplasty has been reported previously. 2,3 Key aspects of management include accurate preoperative definition of the stricture, which is usually possible via retrograde and antegrade urethrography (RUG/VCU...

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Section: Editorial Commentmentioning

confidence: 74%

Section: Fig 3 Distribution Of Posterior Urethroplasty Cases By Agementioning

confidence: 99%

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confidence: 99%

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Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

et al. 2007

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“…The delayed urethroplasty after 3 months after initial trauma reduces complications of impotence and incontinence. In addition, the major advantage of delayed urethral reconstruction is that it can be done under controlled conditions when the patient has recovered from major associated injuries (13).…”

Section: Discussionmentioning

confidence: 99%

Comprehensive analysis of etiology on the prognosis of urethral strictures

Mathur¹,

Aggarwal²,

Satsangi³

et al. 2011

Int. braz j urol.

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Introduction: Urethral strictures remain a reconstructive dilemma, due to high incidence of recurrence and less than satisfactory outcomes. Even experienced surgeons following strict surgical principles have not achieved optimal results, leading us to think whether the etiology of strictures dictate the outcome . We evaluated this "cause-effect" relationship highlighting the significance of the etiology on the overall prognosis of urethral strictures. Materials and Methods: A total of 302 males with urethral strictures were assessed (both retrospectively and prospectively) over a period of ten years. The preoperative evaluation was performed by retrograde urethrogram, urethrosonogram, and uroflowmetry and categorized, based on etiology: a) as post traumatic, b) post infective, c) iatrogenic or d) unknown. Traumatic strictures were subjected to pelvic X-ray and sub-categorized into grades A, B and C, following the TILE classification. Patients were operated; with tunica albuginea urethroplasty for anterior strictures and U shape prostato-bulbar anastomosis for posterior strictures. Results: Traumatic strictures accounted for 54% of cases. 127 of the 302 patients were treated using Tunica Albuginea Urethroplasty, while U shaped Prostatobulbar Anastomosis was performed on others. Post traumatic strictures had best outcome whereas post infective strictures had the worse outcome. Among strictures following pelvic fractures, TILE grades A and B had a better post operative course as compared to TILE C. Overall complication rate was 13.24%. Conclusion: Our study demonstrated that etiology of urethral strictures may play a vital role for the overall prognosis of urethral strictures.

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“…Urethral injuries in males may result in strictures, poor stream, infection, and incontinence, as well as erectile dysfunction [21,22,24,44]. Persisting impotence is estimated to occur in approximately 42% of patients after urethral injury [18], but erectile dysfunction is now recognized in patients with no detectable GUI, with an incidence between 5% and 30% in recent studies depending on how dysfunction is assessed [18,20,24,25,43].…”

Section: Introductionmentioning

confidence: 99%

High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

Odutola

Sabri

Halliday

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. Questions/purposes We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. Methods We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). Results New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1. urinary OR, 4.6; 95% CI,). Conclusions Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. Level of Evidence Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Pelvic Fracture Urethral Injuries: The Unresolved Controversy

Cited by 238 publications

References 59 publications

Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

Urethral Reconstruction for Traumatic Posterior Urethral Disruption: Outcomes of a 25-Year Experience

Comprehensive analysis of etiology on the prognosis of urethral strictures

High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

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