Posterior Urethral Stricture After Pelvic Fracture Urethral Distraction Defects in Developing and Developed Countries, and Choice of Surgical Technique

Kulkarni, Sanjay; Barbagli, Guido; Kulkarni, Jyotsna; Romano, Giuseppe; Lazzeri, Massimo

doi:10.1016/j.juro.2009.11.045

Cited by 56 publications

(29 citation statements)

References 25 publications

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“…The mean age of the patients in current study corresponds with the study of Kulkarni S.B. et al (2010) [16] as they reported a median age of 33 years. Journal of Biosciences and Medicines…”

Section: Discussionsupporting

confidence: 87%

Outcomes of Early Primary Endoscopic Realignment and Delayed Reconstruction in the Management of Posterior Urethral Injury in Male

Huda¹,

Saha²,

Rahman³

et al. 2019

JBM

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Background: Posterior urethral injury usually occurs in male patients with pelvic fractures. Posterior urethral injuries are associated with considerable morbidity including urinary incontinence, erectile dysfunction and urethral stricture. Objective: To compare the outcomes between early primary endoscopic realignment and delayed reconstruction in the management of male patients of posterior urethral injury. Methodology: This prospective study was conducted in the department of urology and department of casualty, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2015 to June 2017 among 50 male patients with posterior urethral injury. Fifty patients were randomly allocated into two groups; the group A consisted of 24 patients underwent early primary endoscopic realignment within 10 days after posterior urethral injury and the group B consisted of 26 patients underwent delayed reconstruction in form of anastomotic urethroplasty after 3 months. All patients were followed up at 3 rd , 6 th and 9 th month after the procedure. Outcome variables were post-operative urethral stricture, urinary incontinence and erectile dysfunction. Data were analyzed and compared by statistical tests. Results: The mean (±SD) age of the study patients was almost sim-How to cite this paper:

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“…The mean age of the patients in current study corresponds with the study of Kulkarni S.B. et al (2010) [16] as they reported a median age of 33 years. Journal of Biosciences and Medicines…”

Section: Discussionsupporting

confidence: 87%

Outcomes of Early Primary Endoscopic Realignment and Delayed Reconstruction in the Management of Posterior Urethral Injury in Male

Huda¹,

Saha²,

Rahman³

et al. 2019

JBM

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“…that lichen sclerosus was responsible for long, complex, multi‐focal strictures in the penile urethra, often requiring multiple interventions. External and iatrogenic trauma was the most important cause of posterior urethral pathology, although this population was much smaller in the present study than that seen in developing countries , or in countries where aggressive treatment for prostate cancer is practised . Nevertheless, this subgroup generated a large number of re‐operations because of the associated complexity.…”

Section: Discussionmentioning

confidence: 67%

Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

2019

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ObjectiveTo conduct an audit of the management of urethral pathology in men presenting for reconstructive urethral surgery in the UK. MethodsBetween 1 June 2010 and 31 May 2017, data on men presenting with urethral pathologies requiring reconstruction were entered onto a secure online data platform. Surgeonentered information was collected in 95 fields regarding the stricture aetiology, prior management, mode of presentation, type of surgery and outcomes, with a potential 283 variable responses in the 95 fields. Data were analysed to compare UK practice with that reported in the contemporary literature and with guidelines. ResultsData on 4809 men were entered by 39 centres and 50 surgeons. Field completeness was 70.7%, 74.3% and 53.7% for preoperative, operative and follow-up data, respectively. Referral for stricture reconstruction frequently followed two prior endoscopic procedures and the stricture was not always assessed anatomically before surgery. Urinary retention was a common symptom in men awaiting reconstruction. Short unifocal strictures of the anterior urethra were the commonest reason for referral, whilst lichen sclerosus and hypospadias generated a significant volume of revisional stricture surgery. Lower numbers of very complex interventions are required for the management of posterior urethral pathology. Although precise criteria for determining success are not clear, management of urethral reconstruction in the UK was found to have a low risk of Clavien-Dindo grade 3 or higher complications, and was associated with outcomes similar to those reported in contemporary series except in the management of posterior urethral fistulae. ConclusionsOnline databases can provide volume data on the management of reconstructive urethral surgery across a multiplicity of centres in one country. They can also indicate compliance with accepted standards of, and expected outcomes from, this tertiary practice.

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“…success rates for all management techniques were 78% and 87%, for india and italy, respectively. 30 Stricture after prostate cancer therapy stricture disease after treatment for prostate cancer can occur anywhere from the bladder neck to urethral meatus. a publication reporting the incidence of stricture disease in patients from the CaPsure (Cancer of the Prostate strategic urologic research endeavor) database revealed an overall stricture treatment rate of 5% among men with a history of treatment for prostate cancer.…”

Section: Recurrent Pfuddsmentioning

confidence: 99%

Complicated urethroplasty: a guide for surgeons

Burks

Santucci

2010

Nat Rev Urol

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Although straightforward male urethral stricture disease is commonly encountered in the scope of general urologic practice, complex urethral strictures are less common and require a more systematic approach. Complex urethral stricture surgery for long and panurethral strictures, after failed hypospadias repair, and for recurrent posterior urethral distraction defects requires a dynamic treatment paradigm. A multistaged urethral reconstruction is often necessary owing to hostile urethral tissue, especially after multiple previous procedures. A perineal urethrostomy sometimes offers improved quality of life for patients with complex urethral stricture disease, particularly if they have undergone previous failed repairs. Recurrent posterior urethral distraction defects are best treated with excision of the scarred urethral segment and re-anastomosis. Urethral stricture disease after treatment for prostate cancer requires multiple treatment approaches given the often poor tissue quality and likelihood of stricture recurrence.

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Posterior Urethral Stricture After Pelvic Fracture Urethral Distraction Defects in Developing and Developed Countries, and Choice of Surgical Technique

Abstract: Differences in emergency treatment for pelvic fracture urethral distraction defects influence the choice of delayed posterior repair and results.

Cited by 56 publications

References 25 publications

Outcomes of Early Primary Endoscopic Realignment and Delayed Reconstruction in the Management of Posterior Urethral Injury in Male

Outcomes of Early Primary Endoscopic Realignment and Delayed Reconstruction in the Management of Posterior Urethral Injury in Male

Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

Complicated urethroplasty: a guide for surgeons

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