Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre

Fu, Qiang; Zhang, Jiong; Yang, Sa; Jin, San-Bao; Xu, Yuhong

doi:10.1111/bju.12171

Cited by 42 publications

(38 citation statements)

References 27 publications

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“…If the length of the urethra is inadequate, the horn of the penis must be split and the lower limb of the pubis must be cut off. According to the investigation data collected by Fu et al [6] on posterior urethral stricture after pelvic fracture, the occurrence rate of erectile dysfunction (ED) in patients after pelvic fracture was 85%. However, the ED occurrence rate after urethroplasty was 86%, indicating that no considerable difference occurred between ED occurrence rate before operation and that after operation.…”

Section: Discussionmentioning

confidence: 99%

“…Although some research showed that this conventional operation method generally does not affect sexual function after operation [6], it damages the surrounding blood vessels and tissue of the posterior urethra, and thus may also disrupt the erectile function to some extent. In this study, the non-transecting anastomotic urethroplasty was put into preliminary clinical practice, and the related indexes concerning operation condition, urinating condition after operation, and erectile function were evaluated to identify the influence of this method on the urination and sexual function of patients with posterior urethral stricture after operation.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty

Zhang

et al. 2017

Front. Med.

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This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture. A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups. In one group, 12 patients underwent non-transecting anastomotic urethroplasty. In the other group, 11 patients underwent conventional posterior urethra end-to-end anastomosis. The effect of operation was evaluated using the following parameters: the bleeding amount during operation, operation time, IIEF-5 scores after operation, maximum flow rate (Qmax), and rating scale of quality of life (QoL). The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time. However, a significant difference was observed between the groups with regard to the bleeding amount during operation. The patients in the group of non-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter. Meanwhile, one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter. Furthermore, significant differences in the operation time, bleeding amount during operation, IIEF-5 scores after operation, and rating scale of QoL were observed, whereas no significant difference was observed between urine flow rates of the two groups after operation. Overall, nontransecting anastomotic urethroplasty is effective for posterior urethra reconstruction, and it can reduce the occurrence rate of erectile dysfunction after operation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty

Zhang

et al. 2017

Front. Med.

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“…71 Fu et al reported that 88% (447/ 510) of the men in a retrospective study at a referral center were continent after delayed urethroplasty. 87 However, the external sphincter can be damaged in complex urethral disruptions or during total excision of scars for even a short urethral stenosis. Urinary continence in such cases depends on bladder neck function.…”

Section: Incontinencementioning

confidence: 99%

Management of male pelvic fracture urethral injuries: Review and current topics

Horiguchi

2019

Int J of Urology

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Pelvic fractures from high‐energy blunt force trauma can cause injury to the posterior urethra, known as pelvic fracture urethral injury, which is most commonly associated with unstable pelvic fractures. Pelvic fracture urethral injury should be suspected if a patient with pelvic trauma has blood at the meatus and/or difficulty voiding, and retrograde urethrography should be carried out if the patient is stable. Once urethral injury is confirmed, urinary drainage should be established promptly by placement of a suprapubic tube or primary realignment of the urethra over a urethral catheter. Although pelvic fracture urethral injury is accompanied by subsequent urethral stenosis in a high rate and it has been believed that primary realignment can reduce the risk of developing urethra stenosis, it also has a risk of complicating stenosis and its clinical significance remains controversial. Once inflammation and fibrosis have stabilized (generally at least 3 months after the trauma), the optimal management for the resulting urethral stenosis is delayed urethroplasty. Delayed urethroplasty can be carried out via a perineal approach using four ancillary techniques in steps (bulbar urethral mobilization, corporal separation, inferior pubectomy and urethral rerouting). Although pelvic trauma can impair continence mechanisms, the continence after repair of pelvic fracture urethral injury is reportedly adequate. Because erectile dysfunction is frequently encountered after pelvic fracture urethral injury and most patients are young with a significant life expectancy, its appropriate management can greatly improve quality of life. In the present article, the key factors in the management of pelvic fracture urethral injury are reviewed and current topics are summarized.

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“…Postoperative recurrence of stricture is also a problem with this procedure. 13 Success rate of perineal anastomotic urethroplasty is 82% to 95% in different studies. 14 Since Webster and Roman reported results of trans-perineal anastomotic urethroplasty for posttraumatic urethral disruption (currently termed as PFUI) with very high success-rate (96%), the method has been considered a gold standard surgery.…”

Section: Introductionmentioning

confidence: 99%

Management of Pelvic Fracture Urethral Injury- 147 Cases

Asad¹,

Zico²,

Hossain³

et al. 2020

KYAMC j.

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Background: Dhaka Medical College Hospital is the highest referral center for PFUI. As anstomotic urethroplasty is a challenging surgery and most of the surgeons refer these type of injuries to our center, we performed this study to evaluate the outcome of our cases. Objective: This study aims to find the outcome and complications of perineal end to end anastomotic urethroplasty in the management of posterior urethral injury resulting from pelvic fracture. Materials and Methods: We performed 147 perineal bulbo-prostatic anastomotic urethroplasty for PFUIs from January, 2013 to May, 2019. Mean age was 37 years with majority between 21 to 50 years (>85%). Nine patients had history of failed anastomotic urethroplasty. After surgical intervention patients were discharged with a supra-pubic catheter (SPC) and per urethral catheter in situ. On 22 nd POD urethral catheter was removed and SPC on the next day if patient can void normally. 1st and 2nd follow up done on of 3 rd and 6 th month respectively following surgery. If patient voided well and Qmax>15ml/ sec; repair was defined as successful. Results: Success rate of anastomotic urethroplasty for PFUI was 93.87%. Total 9 procedures were failed including 2 urethro-cutaneous fistula and needed re-do anastomosis. Erectile dysfunction (ED) was present in 18 patients before operation and after surgery 12 more patients developed ED and total number was 30 during first follow up, which reduced to 24 during second follow-up. Two patient developed incontinence which improved in subsequent follow-up. Conclusion: Anastomotic urethroplasty remains the gold standard in the management of PFUI. Erectile dysfunction is the main issue to be concerned and need special attention.Keywords: Perineal bulbo-prostatic anastomotic urethroplasty, posterior urethral injury, pelvic fracture urethral injury (PFUI), supra-pubic catheter (SPC), failed anastomosis, erectile dysfunction (ED).

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Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre

Cited by 42 publications

References 27 publications

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty

Management of male pelvic fracture urethral injuries: Review and current topics

Management of Pelvic Fracture Urethral Injury- 147 Cases

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